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moderate-r isk mutations CH EK 2 or ATM shou ld not have bi latera l ma s- tectomies solely due to the mutation. Dr. T u n g says t hat pat ient s w it h a n ATM mutation have reg ularly been told they should have a mastectomy because radiation is not a n option, but the new g uidelines recom mend t he option of breast conser vation. "There has been a lot of controversy regarding whether radiation therapy increases local toxicity or CBC in women who have inherited a single ATM mutation," Dr. Tung says. "After reviewing the existing data, the committee feels that radiation should be offered to these patients. We concluded that there are insufficient data to withhold it." Other key takeaways from the guide- lines include: + Patients with metastatic HER2-neg breast cancer who have a germline BRCA mutation should be offered a PARP inhibitor instead of non-plati- num chemotherapy. + Platinum chemotherapy should not added to chemotherapy regimens for BRCA mutation carriers early in treat- ment because it introduces additional toxicity without proven efficacy. + Platinum chemotherapy is preferable to a taxane agent for BRCA mutation carriers with metastatic breast cancer. + For women with BRCA1 or BRCA2 who are having mastectomies, nipple-sparing mastectomy is a reasonable approach if medically appropriate. + Patients with inherited P53 mutations should have a mastectomy and in most cases not receive radiation. Although the guidelines are generally for the treatment of women with breast cancer, Dr. Tung cautions that men who have a family medical history of BRCA1 or BRCA2 mutations should undergo genetic counseling to consider testing. "Men with BRCA2 mutations develop a particularly aggressive type of prostate cancer that has lower survival," Dr. Tung says. "Men with BRCA2 mutations should undergo prostate cancer surveillance and act on any abnormalities immediately." Dr. Tung hopes the guidelines can be updated in future years with additional information as more is known about other mutations. "This is very exciting," Dr. Tung says. "Genetic testing not only helps us to stratify risk for future cancers, and imple- ment risk-based screening and prevention strategies, it now helps us choose the most effective cancer treatment." n A study from the Broad Institute of MIT and Harvard and Dana-Farber Cancer Institute found that almost 50 drugs in a database of 4,518 FDA-approved or drugs otherwise proven safe can kill cancer cells while leaving other cells intact. The study, published in January in the journal Nature Cancer, is the largest of its kind and was applied to 578 cancer cell lines. According to a press release from the Broad Institute, the study's lead scientists did not have high hopes that drugs approved to treat ailments as varied as alcoholism, diabetes, high cholesterol and arthritis (in dogs) could be useful for treating different types of cancers, and they were pleasantly surprised. Many of the drugs appear to kill cancer cells by activating a protein or stabilizing a protein-protein interaction instead of blocking a protein, as most current cancer drugs do. While more research is needed, the study shows promise for possible cancer treat- ments using drugs that are already available, saving millions of dollars in the drug development process. Non-Oncology Drugs Found to Kill Cancer Cells SPECIAL CLINICAL SECTION: ONCOLOGY M D N E W S . C O M /// M D N E W S L O N G I S L A N D ■ 2 0 21 2 3