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Saturday, May 17, 2008

BRCA trial

This page contains some FAQs on the genetic breast cancer trial being carried out by Breakthrough and Cancer Research UK. For more information on the trial go to www.cancerhelp.org.

What is the BRCA trial?

This is a trial for women who have genetic breast cancer (i.e. women who have a BRCA gene mutation). It is based on new research findings, which suggest that for people who have a BRCA gene mutation and whose breast cancer has come back, chemotherapy treatment with carboplatin may work better than the standard breast cancer chemotherapy treatment (docetaxel).

Only 5–10% of breast cancers are caused by BRCA gene mutations. Currently the same chemotherapy drugs are used to treat women with breast cancer whose cancer has come back, whether or not they have the BRCA gene mutation.

In this trial, in order to find out whether giving carboplatin to women with genetic breast cancer will be of more benefit than docetaxel, one group of women in the study will have carboplatin and the other group will have docetaxel. The differences between the two groups will then be compared. Patients are put into each treatment group at random (randomisation is performed by a computer). Overall, out of every three patients in this trial, two will be given carboplatin and one will be given docetaxel. This is called randomisation in a 2:1 ratio.

Who can take part in the trial?

You can take part in the trial if you have a mutation in the BRCA1 or BRCA2 gene and you have had breast cancer in the past that has now come back. This is called recurrent, relapsed, secondary or metastatic breast cancer.

I have had breast cancer. Can I be tested for a BRCA mutation so I know which treatment is best if the cancer comes back?

You can only have genetic testing for a BRCA mutation on the NHS if you have a very strong family history of breast cancer. You can read more about what constitutes a strong family history of breast cancer in the NICE guideline on the management of familial breast cancer. This can be found at www.nice.org.uk in the Clinical Guideline 14 on Familial Breast Cancer: Information for the Public. Examples of what would be considered a very strong family history that would indicate genetic testing on the NHS would be:

  • four relatives (same side of family) with breast/ovarian cancer at any age
  • three relatives (same side of the family) with breast/ovarian cancer under 60
  • two relatives (same side of family) with breast/ovarian cancer under 40
  • a relative with breast and ovarian cancer (two separate primary cancers)
  • two relatives (same side of family) with ovarian cancer – any age.

NB This is not an exhaustive list.

If you have breast cancer that has come back but haven’t been tested for a BRCA mutation (perhaps despite a strong family history), it will not usually be possible to test you on the NHS in order to get into the trial. This is because it would take too long to get a result. Pre-test genetic counselling is also very important otherwise you may end up having a genetic test in a hurry without considering all the implications. Having a genetic test can raise a lot of issues for both you and your family. You can read more about this at (link to genetic testing section of website).

Can I go in this trial if this is the second time my cancer has come back?

No, this trial is only for women with genetic breast cancer whose cancer has come back for the first time.

My hospital is not doing this trial. Can I change to a hospital that is doing the trial?

The trial is a nationwide trial. Not all cancer hospitals have signed up to run the trial, but if you are willing to travel, you should be able to get into the trial somewhere close to you. You can talk to your consultant about this.

Can I be tested for the BRCA genes privately?

There are private genetic testing companies. Some of these will do full screening of the BRCA genes. This may cost up to a few thousand pounds and results may take from 10 days to three weeks.

If a family member has been tested for the mutation and the mutation has been found, you can be tested for that mutation for a few hundred pounds. This is known as a predictive test/founder mutation test.

Most private genetic testing companies require that a doctor signs the request for the test and is responsible for explaining the result.

I have private health insurance. Will they pay for my BRCA test?

You should ask your insurance company about this.

Can you tell me about BRCA gene mutations and melanoma?

Some studies have shown a slightly increased risk of developing melanoma in people who have BRCA2 mutations. It is best to discuss this with your consultant, particularly if other members of your family have had melanoma.

What does 'triple negative' breast cancer mean?

This means that the breast cancer cells do not have oestrogen receptors (ER-negative), progesterone receptors (PR-negative), or human epidermal growth factor receptors (HER2-negative). These cancers may need to be treated slightly differently than other types of breast cancer. Research is being carried out to find the optimum treatment for triple negative breast cancers.

What happens if I am a BRCA mutation carrier and HER2 positive?

Women with BRCA1 or BRCA2 mutations are less likely to be HER2 positive than women with sporadic breast cancer (in sporadic breast cancer, about 1 in 5 women is HER2 positive, but in BRCA carriers this goes down to about 1 in 50). However, if you are a BRCA mutation carrier and HER2 positive, you may still go into this trial and will have Herceptin with your chemotherapy. Your hospital consultant should discuss this additional treatment and any possible side effects with you.

Via: http://www.cancerbackup.org.uk

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