Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
Oncologist. 2023 Jul 5;28(7):565-574. doi: 10.1093/oncolo/oyad123.
In the OlympiA study, 1 year of adjuvant olaparib significantly extended invasive disease-free survival and overall survival. The benefit was consistent across subgroups, and this regimen is now recommended after chemotherapy for germline BRCA1/2 mutation (gBRCA1/2m) carriers with high-risk, HER2-negative early breast cancer. However, the integration of olaparib in the landscape of agents currently available in the post(neo)adjuvant setting-ie, pembrolizumab, abemaciclib, and capecitabine-is challenging, as there are no data suggesting how to select, sequence, and/or combine these therapeutic approaches. Furthermore, it is unclear how to best identify additional patients who could benefit from adjuvant olaparib beyond the original OlympiA criteria. Since it is unlikely that new clinical trials will answer these questions, recommendations for clinical practice can be made through indirect evidence. In this article, we review available data that could help guide treatment decisions for gBRCA1/2m carriers with high-risk, early-stage breast cancer.
在 OlympiA 研究中，1 年的辅助奥拉帕利显著延长了浸润性无病生存期和总生存期。该获益在各亚组中一致，目前对于携带生殖系 BRCA1/2 突变（gBRCA1/2m）、高风险、HER2 阴性早期乳腺癌的患者，在化疗后推荐使用该方案。然而，奥拉帕利与目前在新辅助治疗后环境中可用的药物（如 pembrolizumab、abemaciclib 和卡培他滨）的整合具有挑战性，因为没有数据表明如何选择、排序和/或联合这些治疗方法。此外，目前尚不清楚如何最好地确定除原始 OlympiA 标准之外，还有哪些额外的患者可以从辅助奥拉帕利治疗中获益。由于不太可能有新的临床试验来回答这些问题，因此可以通过间接证据为临床实践提供建议。在本文中，我们回顾了现有数据，这些数据可能有助于指导携带生殖系 BRCA1/2 突变、高风险、早期乳腺癌患者的治疗决策。
