OlympiA trial (2021) studied adjuvant olaparib in early breast cancer. In which patient population was adjuvant olaparib shown to improve invasive disease-free survival?

• A BRCA1/2-mutated HER2-negative high-risk early breast cancer after definitive surgery and standard chemotherapy ✓
• B All triple-negative breast cancer regardless of BRCA status
• C BRCA1/2-mutated HER2-positive early breast cancer
• D HR-positive/HER2-negative BRCA-wild-type high-risk early breast cancer

Explanation

The OlympiA trial (Tutt et al., NEJM 2021) showed that 1 year of adjuvant olaparib significantly improved invasive disease-free survival and distant disease-free survival in patients with germline BRCA1/2 mutations who had HER2-negative (ER+/HER2- or triple-negative) high-risk early breast cancer and had completed standard neoadjuvant or adjuvant chemotherapy. BRCA testing is therefore essential in high-risk early breast cancer. HER2-positive BRCA-mutated breast cancer was excluded from the trial. BRCA-wild-type patients do not derive benefit from PARP inhibitors.

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

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