A triple-negative breast cancer patient with germline BRCA1 mutation achieves residual disease after neoadjuvant chemotherapy. According to the CREATE-X and OlympiA trials, which adjuvant therapeutic strategy improves disease-free survival most significantly?

• A Capecitabine alone as per CREATE-X data
• B Olaparib (PARP inhibitor) alone as per OlympiA data ✓
• C Capecitabine followed by olaparib sequentially
• D Pembrolizumab maintenance immunotherapy

Explanation

The OlympiA trial (Tutt et al., NEJM 2021) showed that adjuvant olaparib for 1 year in high-risk germline BRCA1/2-mutated HER2-negative early breast cancer significantly improved invasive DFS (3-year iDFS 85.9% vs 77.1%). For TNBC without BRCA mutation, CREATE-X demonstrated capecitabine benefit after residual disease. However, in BRCA-mutated TNBC, olaparib specifically exploits synthetic lethality and is now the preferred strategy. Sequential use is not yet standard per current guidelines.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.