In either case, it will be very important both upfront and as we look at combination therapies, to determine which patients optimally benefit and if they are the patients with
defects in homologous recombination who should be tested for genetic changes with the functional homologous recombination defect assay that I mentioned earlier.
BRCA1 / 2 proteins
function in homologous recombination (HR)- mediated DNA repair and cooperate with Fanconi anemia (FA) proteins to maintain genomic integrity through replication fork stabilization.
Indeed, at least in part, the
abnormalities in homologous recombination deficiency have contributed to the very outstanding responses to platinum therapy and very striking new data with PARP (poly [ADP - ribose] polymerase) inhibitors.
While the biology behind this AAV effect remains unclear, it is likely not a coincidence that the AAV genome is composed of single stranded DNA, which is particularly well suited for strand invasion, a key
step in the homologous recombination pathway.
Although the response rate to PARP inhibitors is really quite remarkable, particularly in those with
defects in homologous recombination, it is clear that the majority of these patients will still recur.
If, however, you look at the pathway more broadly and look at any defects in enzyme
involved in homologous recombination, those numbers increase the percentage to somewhere between 50 % and 70 %.
Also, a number of new homologous recombination defect assays have been recently released, including one from the Sanger Institute called HR Detect that may be even more effective in identifying patients with
abnormalities in homologous recombination.
The researchers could demonstrate that CHD1 - depleted cells have defects
in homologous recombination (HR), an important mechanism for repairing breaks in the DNA molecule.
Much of this DNA is no longer capable of moving, but is likely «auditioning» perhaps as a regulator of gene function or
in homologous recombination, which is a type of genetic recombination where the basic structural units of DNA, nucleotide sequences, are exchanged between two DNA molecules to repair breaks in the DNA strands.
This is controversial, since the amount of benefit in those patients without either abnormalities in the pathway or
in the homologous recombination defect assay are really quite modest, and whether this warrants the toxicity of the PARP inhibitors in these circumstances will require additional study.
Dr. Mills: Patients that have defects
in homologous recombination — and the data are clearest with BRCA1 and BRCA2 abnormalities — do have an improved prognosis.