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Review
. 2025 Jun 23:15:1507840.
doi: 10.3389/fonc.2025.1507840. eCollection 2025.

Part II: consensus statements and expert recommendations for BRCA-associated breast cancer in the Asia-Pacific region: clinical management

Yeon Hee Park  1 , Soo Chin Lee  2 , Christian F Singer  3 , Judith Balmaña  4 , Rebecca Alexandra Dent  5 , Veronique Kiak-Mien Tan  6 , Nadia Ayu Mulansari  7 , Mastura Md Yusof  8 , Frances Victoria F Que  9 , Yen-Shen Lu  10 , Napa Parinyanitikul  11 , Cam Phuong Pham  12   13   14 , Nur Aishah Taib  15 , Sun-Young Kong  16 , Yoland Antill  17   18 , Hee Jeong Kim  19
Affiliations
Review

Part II: consensus statements and expert recommendations for BRCA-associated breast cancer in the Asia-Pacific region: clinical management

Yeon Hee Park et al. Front Oncol. .

Abstract

Introduction: Existing 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.

Methods: An 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.

Results: A 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.

Conclusion: Testing 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.

Keywords: BRCA germline pathogenic variants; HER2; PARP inhibitors; early breast cancer; triple-negative breast cancer.

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Conflict of interest statement

Abstract previously presented at ESMO Asia 2023, FPN Final Publication Number: 23P, SL et al. – Reused with permission. YP received honorariums from Novartis, Roche, AstraZeneca, MSD, Daiichi-Sankyo, Pfizer, and Eli Lilly; consulting/advisory board fees from Novartis, Menarini, Eisai, Roche, AstraZeneca, MSD, Daiichi-Sankyo, Pfizer, BIXINK, and Eli Lilly; and grants/contracts from Pfizer, MSD, Roche, AstraZeneca, GenomeInsights, and NGeneBio. SL received honorariums from Novartis, Roche, AstraZeneca, and Pfizer; consulting/advisory board fees from Pfizer, Novartis, Astra Zeneca, Eli Lilly, MSD, Roche, Sanofi, Daiichi Sankyo, Eisai; and grants/contracts from Pfizer, Eisai, Taiho, ACT Genomics, Karyopharm, MSD, and Adagene CS received honorariums from Novartis and Daiichi Sankyo; consulting/expert testimony fees from AstraZeneca, AMGEN, and Novartis; and support for attending meetings/travel from Roche. Judith Balmalña received honorariums and advisory and consulting fees from AstraZeneca and MSD and support for attending meetings/travel from AstraZeneca, MSD, and Eli Lilly. VK-M received honorariums from AstraZeneca, Roche, and Bertis. NM received honorariums from AstraZeneca, Pfizer, MSD, and Novartis. MY received grants or contracts from AstraZeneca, MSD, Astella, Novartis, ARCUS, and Mundi Pharma and honorariums from Astra Zeneca, Johnson and Johnson, Amgen, Roche, Novartis, Pfizer, Zuellig Pharma, Eli Lilly, MSD, and GSK. FQ received honorariums from AstraZeneca, Camber, GMT, Kalbe, Novartis, and Roche; grants or contracts from AstraZeneca; advisory board participation fees from Novartis; and support for attending meetings/travel from AstraZeneca, Camber, and QualiMed. Y-SL received grants or contracts from Novartis, MSD, and AstraZeneca; consulting fees from Novartis, Roche, AstraZeneca, Pfizer, and Daiichi Sankyo; honorarium from Novartis, Roche, AstraZeneca, Pfizer, Daiichi Sankyo, and Eli Lilly; and support for attending meetings/travel from Novartis and MSD. NP received honorariums from MSD, Roche, AstraZeneca, Eli Lilly, Novartis, Eisai, and Pfizer. CP received grants or contracts from AstraZeneca; and honorariums and meeting/travel support from AstraZeneca, MSD, Boehringer Ingelheim, and Roche. NT received consulting fees from AstraZeneca and Zuellig Pharma; honorarium and grant from AstraZeneca; and support for attending meetings/travel from MSD. S-YK received grants from GSK, iMBDx, Osteoneurogen, and GC Genome. YA received grants or contracts from MSD, GSK, Eisai, and AstraZeneca; consulting fees from Eisai; honorarium/advisory fees from Astra Zeneca, Eli Lilly, GSK, and MSD; and support for attending meetings/travel from AstraZeneca. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Process of consensus development eBC, Early breast cancer; HCP, Healthcare practitioner; HER2, Human epidermal growth factor receptor 2; m, Mutation; SCM, Steering committee member.
Figure 2
Figure 2
Modified Delphi method for the development of consensus.
Figure 3
Figure 3
Key recommendations. BC, Breast cancer; CDK4/6i, Cyclin-dependent kinase 4/6 inhibitor; eBC, Early breast cancer; ET, Endocrine therapy; eTNBC, Early triple-negative breast cancer; g, Germline; HER2, Human epidermal growth factor receptor 2; HR, Hormone receptor; m, Mutation; PARPi, Poly (ADP-ribose) polymerase inhibitor; pCR, Pathological complete response.
See this image and copyright information in PMC

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