BRCA Clinics Expand Further Beyond Breast Cancer
A new clinic in San Francisco is opening with an unusual mission: to provide care for people affected by mutations in two particular genes linked to a high risk of cancer. The move highlights the ways growing knowledge about the genetics of the disease is reshaping care for patients.
The clinic, at University of California, San Francisco, will treat patients with abnormalities in the genes known as BRCA1 and BRCA2. The mutations are widely recognized as inheritable causes of breast and ovarian cancers. Less well known is that they also heighten risk of pancreatic, prostate and some other cancers and thus affect both men and women. Clinic leaders say such a varied patient population can best be served with a dedicated clinic providing a comprehensive approach to both research and treatment.
The clinic also fills a need as more family members of BRCA-positive patients get tested and learn they also have a mutation well before any evidence of cancer might emerge. That means a shift from, say, treating a breast-cancer patient with a BRCA mutation toward more patients who have a mutation but are uncertain about which cancer might develop, says Pamela Munster, co-director of the UCSF Center for BRCA Research, which includes the clinic. “In most places, these people have had no place to go,” she says.
(snip)
“It doesn’t matter what kind of tumor it is, the biology is the same,” says Susan Domchek, executive director of the Basser Center. BRCA “is a good example of why studying a specific gene can have wide implications for many different tumor types.”
Cancer treatment generally is organized around separate departments for each type of cancer. BRCA patients can feel like they’re falling through the cracks. The San Francisco clinic, which offers such services as genetic counseling, imaging and appointments with surgeons, oncologists and other specialists across a variety of relevant disciplines, is meant to treat all BRCA-positive patients, with or without cancer, under the same roof.
(snip)
Dr. Ashworth and Dr. Munster, who is also the cancer center’s director of early phase clinical trials, bring different backgrounds to the initiative. Dr. Ashworth helped discover the BRCA2 mutation two decades ago and more recently helped develop a new class of drugs called PARP-inhibitors to target the mutations. The U.S. Food and Drug Administration approved the first such drug, AstraZeneca ’s olaparib, for ovarian cancer just over a year ago.
Dr. Munster understands the patient’s perspective. She was diagnosed with a BRCA2 mutation in 2012 at age 48 and, as women in this circumstance often do, she chose to have her breasts and ovaries removed. But even as she was seeing BRCA patients as part of her UCSF practice, she says she wasn’t sure where to turn for her own follow-up care. “I was seeing my field from the other side,” she says. Providing a coordinated approach for prevention and treatment is one of the clinic’s chief goals.
The U.S. Centers for Disease Control and Prevention says about one in 500 people have one or the other of the anomalies, though the rate is much higher—about one in 40—among people of Ashkenazi Jewish descent. Together the mutations account for between 5% and 10% of breast cancers in the U.S. and about 15% of ovarian cancers, according to the National Cancer Institute.
(snip)
There wasn’t any evidence of cancer in Dr. Munster’s family when she was diagnosed with ductal carcinoma in situ of the breast—the earliest stage of breast cancer—after her mammogram in 2012. It was the unusual nature of the cancer cells that prompted her to get tested for BRCA. After her diagnosis, she had her father tested for the mutation. Her mother was from a large family with no cancer history, and her speculation that her father was the carrier proved correct.
A few months later, she says, when her father complained of abdominal pains, she insisted he immediately be evaluated for pancreatic cancer—a step that normally would have been far down the list of tests for such symptoms. When cancer was confirmed, she convinced his doctors to treat him with platinum-based chemotherapy, which is known to be effective against BRCA-related ovarian cancer but not generally prescribed for pancreas tumors. The one-year survival rate for patients with pancreatic cancer is 20%, according to the American Cancer Society. Her father is doing well 2½ years later. Dr. Munster, as part of her clinic’s program, plans regular checkups for pancreatic cancer.
(snip)
A long-term goal for the program, adds Dr. Ashworth, is to develop strategies that would enable women to avoid having breasts and ovaries removed, procedures that currently offer the best chance for preventing cancer or halting its progression beyond those organs. “This is a high-risk group,” he says. “This is a place to think about preventive strategies for all cancers.”
Write to Ron Winslow at ron.winslow@wsj.com
http://www.wsj.com/articles/brca-clinics-expand-further-beyond-breast-cancer-1456170654