Part II: consensus statements and expert recommendations for BRCA-associated breast cancer in the Asia-Pacific region: clinical management
IntroductionExisting guidelines have practical gaps in decision and treatment sequencing for BRCA germline pathogenic variant breast cancers. This paper aims to develop clinical-practice consensus guidelines to address these gaps in the clinical management of BRCA germline pathogenic variants-associ...
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Frontiers Media S.A.
2025-06-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2025.1507840/full |
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| author | Yeon Hee Park Soo Chin Lee Christian F. Singer Judith Balmaña Rebecca Alexandra Dent Veronique Kiak-Mien Tan Nadia Ayu Mulansari Mastura Md. Yusof Frances Victoria F. Que Yen-Shen Lu Napa Parinyanitikul Cam Phuong Pham Cam Phuong Pham Cam Phuong Pham Nur Aishah Taib Sun-Young Kong Yoland Antill Yoland Antill Hee Jeong Kim |
| author_facet | Yeon Hee Park Soo Chin Lee Christian F. Singer Judith Balmaña Rebecca Alexandra Dent Veronique Kiak-Mien Tan Nadia Ayu Mulansari Mastura Md. Yusof Frances Victoria F. Que Yen-Shen Lu Napa Parinyanitikul Cam Phuong Pham Cam Phuong Pham Cam Phuong Pham Nur Aishah Taib Sun-Young Kong Yoland Antill Yoland Antill Hee Jeong Kim |
| author_sort | Yeon Hee Park |
| collection | DOAJ |
| description | IntroductionExisting guidelines have practical gaps in decision and treatment sequencing for BRCA germline pathogenic variant breast cancers. This paper aims to develop clinical-practice consensus guidelines to address these gaps in the clinical management of BRCA germline pathogenic variants-associated breast cancer in the Asia-Pacific region.MethodsAn expert panel of 16 medical oncologists, geneticists, and breast cancer surgeons from the Asia-Pacific region arrived at 25 statements. The high level of consensus of statements was considered at ≥75%. A survey of 134 healthcare practitioners, breast cancer surgeons, geneticists, oncologists, molecular biologists/pathologists explored the real- world practices in the Asia-Pacific region.ResultsA consensus was reached for 80% of the statements (20/25) and aligned with the international guidelines. A significant gap was observed between real-world practices and the recommendations of the steering committee members in discussing contralateral risk reducing mastectomy with the patients as a part of standard practice, considering poly ADP-ribose polymerase inhibitor (PARPi) + immunotherapy for early triple negative breast cancer (eTNBC) patients with BRCA variants who don’t achieve pathological complete response after neoadjuvant chemotherapy + immunotherapy, use of adjuvant PARPi in patients with BRCA germline pathogenic variants in eTNBC who have achieved pathological complete response from neoadjuvant therapy, and preference for endocrine therapy + PARPi over endocrine therapy + cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) as escalated adjuvant treatment for BRCA pathogenic variants with high-risk hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-negative) early breast cancer.ConclusionTesting for BRCA germline pathogenic variants should be expanded to include all young patients with breast cancer. Patients with BRCA germline pathogenic variants should undergo genetic testing before surgery as it can impact surgical intervention decisions and further systemic treatment. The use of neoadjuvant platinum agents in chemotherapy increases the pathological complete response rate. Adjuvant PARPi is preferred over CDK4/6i as escalated treatment in patients who are HR+/HER2-negative. |
| format | Article |
| id | doaj-art-44ffbe717902487884271db5ba3e89fd |
| institution | DOAJ |
| issn | 2234-943X |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Oncology |
| spelling | doaj-art-44ffbe717902487884271db5ba3e89fd2025-08-20T03:22:39ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-06-011510.3389/fonc.2025.15078401507840Part II: consensus statements and expert recommendations for BRCA-associated breast cancer in the Asia-Pacific region: clinical managementYeon Hee Park0Soo Chin Lee1Christian F. Singer2Judith Balmaña3Rebecca Alexandra Dent4Veronique Kiak-Mien Tan5Nadia Ayu Mulansari6Mastura Md. Yusof7Frances Victoria F. Que8Yen-Shen Lu9Napa Parinyanitikul10Cam Phuong Pham11Cam Phuong Pham12Cam Phuong Pham13Nur Aishah Taib14Sun-Young Kong15Yoland Antill16Yoland Antill17Hee Jeong Kim18Division of Haematology-Oncology, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of KoreaDepartment of Haematology-Oncology, National University Cancer Institute, Singapore, SingaporeDepartment of Obstetrics and Gynaecology, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, AustriaDepartment of Medical Oncology, University Hospital Campus Vall Hebron, Barcelona, SpainDivision of Medical Oncology, National Cancer Centre Singapore, Singapore, SingaporeDepartment of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, SingaporeHaematology-Medical Oncology Division, Internal Medicine Department, Cipto Mangunkusumo National General Hospital/Universitas Indonesia, Jakarta, IndonesiaPicaso Cancer Centre, Hospital Picaso, Petaling Jaya, Selangor, MalaysiaDepartment of Internal Medicine and Oncology, St Luke’s Medical Center, Quezon City and Global City, Metro Manila, Philippines0Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan1Medical Oncology Unit, King Chulalongkorn Memorial Hospital, Bangkok, Thailand2The Nuclear Medicine and Oncology Center, Bachmai Hospital, Hanoi, Vietnam3Nuclear Medicine Department, Hanoi Medical University, Hanoi, Vietnam4Oncology and Nuclear Medicine Department, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam5Department of Surgery, Faculty of Medicine, University Malaya, UM Cancer Research Institute, Kuala Lumpur, Malaysia6Department of Laboratory Medicine and Genetic Counselling Clinic, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea7Familial Cancer Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia8Faculty of Medicine and Health Sciences, Monash University, Melbourne, VIC, Australia9Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of KoreaIntroductionExisting guidelines have practical gaps in decision and treatment sequencing for BRCA germline pathogenic variant breast cancers. This paper aims to develop clinical-practice consensus guidelines to address these gaps in the clinical management of BRCA germline pathogenic variants-associated breast cancer in the Asia-Pacific region.MethodsAn expert panel of 16 medical oncologists, geneticists, and breast cancer surgeons from the Asia-Pacific region arrived at 25 statements. The high level of consensus of statements was considered at ≥75%. A survey of 134 healthcare practitioners, breast cancer surgeons, geneticists, oncologists, molecular biologists/pathologists explored the real- world practices in the Asia-Pacific region.ResultsA consensus was reached for 80% of the statements (20/25) and aligned with the international guidelines. A significant gap was observed between real-world practices and the recommendations of the steering committee members in discussing contralateral risk reducing mastectomy with the patients as a part of standard practice, considering poly ADP-ribose polymerase inhibitor (PARPi) + immunotherapy for early triple negative breast cancer (eTNBC) patients with BRCA variants who don’t achieve pathological complete response after neoadjuvant chemotherapy + immunotherapy, use of adjuvant PARPi in patients with BRCA germline pathogenic variants in eTNBC who have achieved pathological complete response from neoadjuvant therapy, and preference for endocrine therapy + PARPi over endocrine therapy + cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) as escalated adjuvant treatment for BRCA pathogenic variants with high-risk hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-negative) early breast cancer.ConclusionTesting for BRCA germline pathogenic variants should be expanded to include all young patients with breast cancer. Patients with BRCA germline pathogenic variants should undergo genetic testing before surgery as it can impact surgical intervention decisions and further systemic treatment. The use of neoadjuvant platinum agents in chemotherapy increases the pathological complete response rate. Adjuvant PARPi is preferred over CDK4/6i as escalated treatment in patients who are HR+/HER2-negative.https://www.frontiersin.org/articles/10.3389/fonc.2025.1507840/fullBRCA germline pathogenic variantsearly breast cancerHER2PARP inhibitorstriple-negative breast cancer |
| spellingShingle | Yeon Hee Park Soo Chin Lee Christian F. Singer Judith Balmaña Rebecca Alexandra Dent Veronique Kiak-Mien Tan Nadia Ayu Mulansari Mastura Md. Yusof Frances Victoria F. Que Yen-Shen Lu Napa Parinyanitikul Cam Phuong Pham Cam Phuong Pham Cam Phuong Pham Nur Aishah Taib Sun-Young Kong Yoland Antill Yoland Antill Hee Jeong Kim Part II: consensus statements and expert recommendations for BRCA-associated breast cancer in the Asia-Pacific region: clinical management Frontiers in Oncology BRCA germline pathogenic variants early breast cancer HER2 PARP inhibitors triple-negative breast cancer |
| title | Part II: consensus statements and expert recommendations for BRCA-associated breast cancer in the Asia-Pacific region: clinical management |
| title_full | Part II: consensus statements and expert recommendations for BRCA-associated breast cancer in the Asia-Pacific region: clinical management |
| title_fullStr | Part II: consensus statements and expert recommendations for BRCA-associated breast cancer in the Asia-Pacific region: clinical management |
| title_full_unstemmed | Part II: consensus statements and expert recommendations for BRCA-associated breast cancer in the Asia-Pacific region: clinical management |
| title_short | Part II: consensus statements and expert recommendations for BRCA-associated breast cancer in the Asia-Pacific region: clinical management |
| title_sort | part ii consensus statements and expert recommendations for brca associated breast cancer in the asia pacific region clinical management |
| topic | BRCA germline pathogenic variants early breast cancer HER2 PARP inhibitors triple-negative breast cancer |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2025.1507840/full |
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