1. Ovarian cancer in BRCA mutation carriers: improved outcome after intraperitoneal (IP) cisplatin
- Author
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Susan Edwards, Franco M. Muggia, Robert C. Wallach, Maryann Kwa, Elsa Reich, Andrea Downey, and John P. Curtin
- Subjects
Oncology ,medicine.medical_specialty ,Heterozygote ,endocrine system diseases ,Carboplatin ,Clinical Trials, Phase II as Topic ,Floxuridine ,Surgical oncology ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Survival rate ,Etoposide ,Aged ,Cisplatin ,BRCA2 Protein ,Ovarian Neoplasms ,Clinical Trials, Phase I as Topic ,business.industry ,BRCA1 Protein ,BRCA mutation ,Middle Aged ,medicine.disease ,Prognosis ,female genital diseases and pregnancy complications ,Cystadenocarcinoma, Serous ,Survival Rate ,Mutation ,Surgery ,Topotecan ,Female ,Neoplasm Grading ,Neoplasm Recurrence, Local ,business ,Ovarian cancer ,Injections, Intraperitoneal ,medicine.drug ,Follow-Up Studies - Abstract
Ovarian cancer arising in women with BRCA mutations is known to have a more favorable outcome and to be more responsive to platinum-based regimens than in those without a hereditary background. We analyze our previously published intraperitoneal (IP) studies in relation to BRCA mutation status and update their outcomes. Among 62 patients with ovarian cancer enrolled in IP platinum doublet studies in clinical trials (with etoposide (n = 18), with floxuridine (n = 30), and with topotecan (n = 14)), a deleterious BRCA mutation was eventually identified in 10 patients. The outcomes in these BRCA mutation carriers are described and compared with survival of others in respective trials. Ten patients that were confirmed to have BRCA mutations—all with high-grade and stages IIC to IV disease—survived a median of 10 years (range: 4–18+) after receiving IP cisplatin-based regimens. Two continue with no evidence of disease since their IP treatment, while four others remain alive with recurrences after 8, 9, 10, and 11 years, respectively. This experience suggests that IP cisplatin leads to favorable long term outcomes in advanced ovarian cancer in women with defective homologous recombination (i.e., with deleterious BRCA mutations). Whether such cisplatin dose-intensification from IP relative to (intravenous) IV drug administration leads to superior results in these mutation carriers requires further study.
- Published
- 2012