BRCA2 positive - need for PARP inhibi... - Advanced Prostate...

Advanced Prostate Cancer

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BRCA2 positive - need for PARP inhibitor; Rucaparib, others?

HopingForTheBest1
HopingForTheBest1

MO told me that I was doing a tremendous job researching my PCa disease, but also suggested I get genetic testing by taking the Color saliva test. I did, and got the results several days ago. I am positive for the BRCA2 gene mutation.

As part of the Color program, which costs just $99 for the test, I was entitled to a call with a genetics counselor. I was told that having the mutation predisposes me to aggressive metastatic PC, which I was diagnosed with in June 2018. So I ask myself what if I had known then what I know now; should I have had the test years ago?. But, despite my family history of my father, mother and only sibling sister who all died of different cancers, I had been told that none were known to be hereditary. Now I need to tell my two daughters (age 34 and 38), and make sure they get tested. I feel horrible about this. It's bad enough that I am fighting cancer. Now my children will need to be very vigilant should they be tested positive, hopefully god forbid catching either breast or ovarian cancer early enough. While it is still better to know than not, it is devastating news!

Now I have continued to do research, and found that maybe using a PARP inhibitor could be helpful for me. Asked my oncologist (not the one that said I should consider the Color test) about the TRITON2 study, and Rucaparib. He told me that CINJ, where he works, was a participant in the trial. He understands that the study addressed castrate resistant patients, which I am not. I am on Eligard, Zytiga. Prednisone and Xgeva, which are working for me now with PSA down from 20 to 0.2 in 3 months. Also having robotic prostatectomy this Nov 14 as part of the SIMCAP clinical trial.

Should I consider adding Rucaparib at this point, or wait until I become castrate resistant??? Also, what about using other PARP inhibitors, if available, such as Lynparza, Olaparib, Nanotization or chemo carboplatin?

8 Replies

I have same mutation and struggled with the same choice. I have already posted about it elsewhere on this forum. There is no answer, and the choice depends on you and your MO. I spoke to five different cancer centers, four of them said I shouldn’t , and one said I should. The reason for not starting is early resistance. There are new combination therapies with PARP plus another agent that are being investigated that may prove to be more beneficial.

Again, it’s a tough call.

There is an argument that favors early use---it tends to be used after Castrate Resistance, and 2nd line ADT, and some will not use until after Chemo----All 3 you mentioned--PARP's are being used. I also and my Brother have the BRCA--and Pca. All Kids had to be genetically tested--If you have a Geneticist---get an opinion---or if you are or can be in communication with A head of clinical trials at big Cancer Center, get a recommendation

As for early use, you may or may not qualify for the new national LAW Of Right to Use. I think here you have to be in desperate need. Check top resources.

Some Docs. will go off label, and provide, if they have---Dana Farber announced the great results they got with Nano--Olaparib---but cannot find where it is in test. But I have not looked hard either. You can call Foundation Medicine--or Foundation One---where I communicate with a Geneticist---but I am a customer--I had 328 Genes evaluated.

Nalakrats

Also try contacting my clinical Trials adviser--Try emailing[ jbota@emergingmed.com],

I use to have a tel number--you may find by google on emergingmed----they have their hands on all clinical trials--I cannot give you my name as a reference--see what you can do.

Nalakrats

The question is - how will you get and pay for a PARP inhibitor? Insurance won't pay for it. Lynparza is available off-label.

vandy69
vandy69 in reply to Tall_Allen

Hi TAll_Allen,

Dr. Myers was able to prescribe Lynparza and Medicare paid for it after Guardant360 liquid biopsy detected ATM defect. Worked for about 9 months.

Best wishes. Never Give In.

Mark, Atlanta

Tall_Allen
Tall_Allen in reply to vandy69

Sometimes insurance/Medicare will approve an off-label drug if the MO makes a good case for it. Always worth a try!

I just sent a new post thinking I was replying. (brain fog )

Received my gene panel a couple days ago won't see MO until Dec.

Researching now. Any insight would be appreciated. I'm castrate resistant.

Cancer stable at 3.5. I have two sons I have to inform.

8/31/2018- PGDX gene panel reported the following:

--Microsatellite stable

--Sequence mutations: BRCA2 (E1646G, E1646Kfs*24), EP300 (G194A), IDH2 (D225N).

--No amplification or translocations

***BRCA2 (E1646Kfs*24)- this mutation may render the patient potentially

responsive to PARP inhibitor such as Olaparib.

I feel blessed to have found this forum. Thank you all for sharing your wisdom.

Hidden
Hidden

I am hoping for the best for you also .. I believe that you’ll find the best path forward.. You ‘re faced with so many decisions right now... take time each day to “Not lament” over PC... .APC and treatments will show us our every weakness.. It’s a bumpy road...Eat healthy, stay active and live long 😎

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