Discussion on the use of taxanes for treatment of breast cancers in BRCA1 mutations carriers

Byrski et al. in the article Response to neo-adjuvant chemotherapy in women with BRCA1 positive breast cancer confirm that use of taxane in neo-adjuvant chemotherapy is not effective for treatment in women with positive BRCA1 breast cancer.Independently, on a small number of studied patients, the results and conclusions of the study make it possible to form the opinion that it is really necessary to change the view on combination of chemotherapy (including neo-adjuvant) with other treatment methods of women with BRCA1 positive breast cancer. Another conclusion: there is no difference in response between negative oestrogen receptor (ER) and positive ER to taxane neo-adjuvant chemotherapy. So we need to develop a strategy of hereditary cancer identification by BRCA1 mutation testing only after that to consider using taxane in neo-adjuvant chemotherapy.These results are very interesting and important. In the Czech Republic (CR), we have a large series of women with breast cancer tested for BRCA1 and BRCA2 mutations. The situation with genetic testing is more complicated in the CR since the germline mutations are scattered through the whole BRCA1 or BRCA2 gene and complete testing of both genes is required. We have not done any analysis of retrospective data on neo-adjuvant chemotherapy in BRCA1 carriers with breast cancer in our cohort of tested patients yet, and thus we cannot discuss your results. But my suggestion is to get together a large retrospective study of all BRCA1 positive breast cancer patients within Europe (or elsewhere) and have really very conclusive results. The data are available in each centre and a large multinational study should not be a big problem.Your suggestion of having all breast cancer patients tested for BRCA1 mutations before chemotherapy is unrealistic in the Czech Republic. The testing requires rather complicated analysis of the whole gene and the insurance would not pay for it. So far we have tested women with breast cancer if they fu