American Society for Radiation OncologyOncology2021advanced

Management of Hereditary Breast Cancer

Published by American Society of Clinical Oncology (ASCO)

1Recommendations

4References

1Tables

Summary

AI-generated

This ASCO Rapid Recommendation Update advises that one year of adjuvant olaparib should be offered to patients with high-risk, early-stage, HER2-negative breast cancer and germline BRCA1 or BRCA2 mutations after completing local treatment and chemotherapy, based on the efficacy results from the OlympiA phase III trial.

hereditary breast cancerolaparibBRCA1BRCA2ASCOoncologyguidelinesrecommendations

Key Takeaways

1
One year of adjuvant olaparib is recommended for early-stage, HER2-negative breast cancer patients with a high risk of recurrence and germline BRCA1/2 mutations.
2
Treatment should be offered after completing local treatment and (neo)adjuvant chemotherapy.
3
Specific eligibility depends on whether patients received surgery first or neoadjuvant chemotherapy, along with factors like tumor size, node involvement, and CPS+EG scores.

What's New in This Version

The 2020 guideline stated there was insufficient data to recommend PARP inhibitors for nonmetastatic breast cancer. The 2021 update changes this to strongly recommend 1 year of adjuvant olaparib based on the OlympiA phase III trial data demonstrating significant improvements in invasive and distant disease-free survival.

Key Recommendations

2021 UPDATED RECOMMENDATION

rec_1
For patients with early-stage, HER2-negative breast cancer with high risk of recurrence and germline BRCA1 or BRCA2 pathogenic or likely pathogenic variants, one year of adjuvant olaparib should be offered after completion of (neo)adjuvant chemotherapy and local treatment, including radiation. For those who had surgery first, 1 year of adjuvant olaparib should be offered for patients with triple-negative breast cancer and tumor size > 2 cm or any involved axillary nodes. For those with hormone receptor–positive disease, 1 year of adjuvant olaparib should be offered to those with at least four involved axillary lymph nodes. For patients who had neo-adjuvant chemotherapy, 1 year of adjuvant olaparib should be offered to patients with triple-negative breast cancer and any residual cancer; for patients with hormone receptor–positive disease, 1 year of adjuvant olaparib should be offered to patients with residual disease and a clinical stage, pathologic stage, estrogen receptor, and tumor grade score >= 3.
Adjuvant Therapy

Scope & Objectives

Clinical Topic

Hereditary Breast Cancer

Objectives

To disseminate updated recommendations, in a timely manner, to better inform health practitioners and the public on the best available cancer care options regarding adjuvant PARP inhibitors.

Target Patient Population

Patients with early-stage, HER2-negative breast cancer with high risk of recurrence and germline BRCA1 or BRCA2 pathogenic or likely pathogenic variants.

Target Providers

Health practitionersOncologists

Patient Criteria & Setting

Therapeutic Area

Oncology

Guideline Scope

TreatmentAdjuvant Therapy

Inclusion Criteria

Early-stage, HER2-negative breast cancer
High risk of recurrence
Germline BRCA1 or BRCA2 pathogenic or likely pathogenic variants
Completed local treatment and at least six cycles of (neo)adjuvant chemotherapy

Special Populations

Germline BRCA mutation carriers

Authors & Contributors

Nadine M. TungMD; Dana ZakalikMD; Mark R. SomerfieldPhD

Guideline Features

Based on systematic reviewMultidisciplinary

Learning Context

Difficulty

advanced

Learning Paths

Breast CancerHereditary Cancer SyndromesBRCA1/BRCA2 MutationsPARP InhibitorsAdjuvant TherapyTargeted Therapy