TRANSCRIPTION:
DR LOVE: Just finishing out on BRCA: In the past we’ve talked about BRCAness and, also, more recently, the concept of somatic BRCA mutations, which is something I’ve heard in the GYN discussions. What do we know about that and response to PARP inhibitors? And anything in your I-SPY efforts that gives you any clues about that?
DR RUGO: Certainly in I-SPY, which is a biomarker-rich trial, we’re doing a lot of work to try and identify the characteristics that increase chance of response in this setting. So we had the PARP inhibitor, veliparib, and we looked at this PARPi7. It’s PARP inhibitor 7 gene signature. And that suggested that potentially we could identify a group of patients who benefited, but it’s not enough data yet.
We actually are opening an arm in I-SPY that includes the PARP inhibitor that has trapping, talazoparib, along with irinotecan. And actually, it’s a low dose of irinotecan that is supposed to improve the ability of talazoparib to cause cancer cell death by priming the cells in an important way. Since irinotecan we don’t use much with breast cancer, I think it’s going to give us some very early signals about efficacy and also give us biomarkers.
I think that BRCAness idea seems, to me, very complicated. And whether or not we get to that by looking at HRD, homologous recombination defects, in the early-stage setting remains to be seen. At Dana-Farber, they’re doing an interesting study looking at platinum versus anthracycline as neoadjuvant therapy and looking for these biomarkers to try and help us figure out what BRCAness actually means.
And then I think this explosion of blood markers, looking at circulating DNA in the blood, is quite fascinating. And I just went to a symposium on this. And I think that if you have a sensitive and specific test, that may allow us to look for somatic mutations in patients more easily than we have been able to before.
T, AC