6
Management
Recommendation 6.3
➤ For women with breast cancer who are carriers of a germline TP53
mutation, radiotherapy of the intact breast is contraindicated.
Mastectomy is the recommended therapeutic option.
Postmastectomy radiation therapy should only be considered in
patients with significant risk of locoregional recurrence. (Moderate
recommendation; FC-L)
Recommendation 7
➤ When offering chemotherapy for germline BRCA mutation carriers
with metastatic breast cancer, platinum chemotherapy is preferred
to taxane therapy for patients who have not previously received
platinum. There are no data to address platinum efficacy in other
germline mutation carriers. (Moderate recommendation; EB-I)
Recommendation 8
➤ For germline BRCA mutation carriers with breast cancer treated with
(neo)adjuvant therapy, data do not support the routine addition of
platinum to anthracycline and taxane-based chemotherapy. While
single-agent platinum has demonstrated activity in the neoadjuvant
setting, there are no data yet comparing it to standard chemotherapy.
There are no data to address platinum efficacy in other germline
mutation carriers. (Moderate recommendation; EB-I)
Recommendation 9.1
➤ For BRCA1/2 mutation carriers with metastatic HER2-negative breast
cancer, olaparib or talazoparib should be offered as an alternative
to chemotherapy in the 1st-3rd line setting. For BRCA1/2 mutation
carriers with metastatic HER2-negative breast cancer, there are
no data directly comparing efficacy of PARP inhibitor to platinum
chemotherapy. (Strong recommendation; EB-H)
Recommendation 9.2
➤ For breast cancer patients with mutations in moderate-penetrance
genes, there are currently no robust data to support the use of PARP
inhibitors. (Moderate recommendation; IC-Ins)
