2008 February 28; 451(7182): 1116–1120 | Wataru Sakai, Elizabeth M. Swisher, Beth Y. Karlan, Mukesh K. Agarwal, Jake Higgins, Cynthia Friedman, Emily Villegas, Céline Jacquemont, Daniel J. Farrugia, Fergus J. Couch, Nicole Urban, and Toshiyasu Taniguchi
This study investigates the mechanism of cisplatin resistance in cancers with *BRCA2* mutations. The authors found that acquired resistance to cisplatin can be mediated by secondary intragenic mutations in *BRCA2* that restore the wild-type *BRCA2* reading frame. They demonstrated this in a cisplatin-resistant *BRCA2*-mutated breast cancer cell line, HCC1428, and a *BRCA2*-mutated pancreatic cancer cell line, Capan-1. In HCC1428, a secondary genetic change in *BRCA2* rescued *BRCA2* function, making the cells resistant to cisplatin. In Capan-1, cisplatin selection led to five different secondary mutations that restored the wild-type *BRCA2* reading frame, and these clones were resistant to both cisplatin and a poly(ADP-ribose) polymerase (PARP) inhibitor. The authors also evaluated recurrent cancers from patients with primary *BRCA2*-mutated ovarian carcinomas treated with cisplatin and found that the recurrent tumor that acquired cisplatin resistance had undergone reversion of its *BRCA2* mutation. These findings suggest that secondary mutations restoring the wild-type *BRCA2* reading frame may be a major clinical mediator of acquired resistance to platinum-based chemotherapy.This study investigates the mechanism of cisplatin resistance in cancers with *BRCA2* mutations. The authors found that acquired resistance to cisplatin can be mediated by secondary intragenic mutations in *BRCA2* that restore the wild-type *BRCA2* reading frame. They demonstrated this in a cisplatin-resistant *BRCA2*-mutated breast cancer cell line, HCC1428, and a *BRCA2*-mutated pancreatic cancer cell line, Capan-1. In HCC1428, a secondary genetic change in *BRCA2* rescued *BRCA2* function, making the cells resistant to cisplatin. In Capan-1, cisplatin selection led to five different secondary mutations that restored the wild-type *BRCA2* reading frame, and these clones were resistant to both cisplatin and a poly(ADP-ribose) polymerase (PARP) inhibitor. The authors also evaluated recurrent cancers from patients with primary *BRCA2*-mutated ovarian carcinomas treated with cisplatin and found that the recurrent tumor that acquired cisplatin resistance had undergone reversion of its *BRCA2* mutation. These findings suggest that secondary mutations restoring the wild-type *BRCA2* reading frame may be a major clinical mediator of acquired resistance to platinum-based chemotherapy.