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Is there adequate evidence for the use of PARPi in combination with ARSI for BRCA+/HRR mutated mCRPC as compared to sequential therapy?

What would be your treatment approach in a premenopausal BRCA2+ patient with cT2N0 grade 2-3, ER negative, PR variably positive (30%; staining weak to high), HER2 negative breast cancer?

Would you still treat with neoadjuvant KEYNOTE-522?

Would you consider a BRCA carrier patient for kidney transplantation?

Should we start performing universal germline mutation testing for all newly diagnosed breast cancer?

Given OlympiA trial with olaparib benefit for gBRCA+ patients?What are barriers that you foresee? In your practice who performs mutation testing and w...

For patients with triple negative breast cancer who have a minimal response to neoadjuvant chemotherapy, do you do additional testing to sub-categorize the cancer and find a potential target (e.g. androgen receptor, etc)?

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How strict are you about adhering to the eligibility criteria required for entry onto the OlympiA trial in considering a year of adjuvant olaparib as adjuvant therapy for BRCA mutated, node positive, ER positive breast cancer?

If a patient had a CPS-EG of 2 after neoadjuvant therapy, would you offer that patient olaparib even though she wouldn't have met entry criteria? If t...

What is the optimal sequence of available therapies in patients with BRCA+/HRR mCRPC after progression on first line combinations?

If a patient has already received ADT+ARSI would you use PARPi over chemotherapy in 2nd line?

Will prior novel hormonal therapy affect when/how you use olaparib plus abiraterone for patients with BRCA-mutated metastatic castration resistant prostate cancer?

How should we think about endocrine resistance in patients with inherited germline mutations such as BRCA, CHEK2, etc.?

Should these patients have a different threshold for utilizing a CDK4/6 inhibitor in the front line metastatic or as part of adjuvant therapy, or SERD...

Are there any scenarios in which you would consider use of PARPi in the upfront mCSPC setting rather than reserving for CRPC?

In the absence of a cohesive workflow guiding the use of PARPi in ovarian cancer since the 2022 FDA approval withdrawals, what is your general approach to PARPi usage in the front-line and recurrent setting?

Would you offer adjuvant olaparib to a male patient with HR+, HER2- T2N0 breast cancer with a BRCA2 germline mutation following mastectomy who is not a candidate for adjuvant chemotherapy?

Given more restrictions on later line PARP inhibitor use for patients by BRCA status, would you consider repeat biopsy with somatic testing to identify candidates for second line maintenance therapy following platinum treatment for a patient who is gBRCAwt?

Does your approach change depending on the patients initial somatic BRCA status?

Do you prefer CDK 4/6 inhibitor or PARP inhibitor as first line treatment in a patient with HR+/HER2 neg relapsed/metastatic BRCA positive breast cancer who had previous adjuvant chemotherapy and developed metastatic recurrence while on AI?

6 Answers available

How do you decide between 1st line PARPi or immunotherapy in a patient with metastatic gBRCA mutated TNBC?

Received neoadjuvant ddAC/T followed by adjuvant capecitabine for residual disease and found to have metastatic pulmonary nodules within months of sur...

How do you decide between a PARP inhibitor or alpelisib for patients with metastatic ER+, gBRCA+, PI3K mutated breast CA with progression on CDK 4/6 inhibitor/fulvestrant?

Would you recommend olaparib for a patient with germline BRCA1 mutation and HER2+ metastatic breast cancer who has progressed through multiple lines of HER2-directed therapy including trastuzumab deruxtecan?

Does your approach differ across the HER2 IHC spectrum?

Do you prefer using an anthracycline or non-anthracycline adjuvant regimen in BRCA+ premenopausal patients with localized HR+ breast cancer?

Assuming chemotherapy is indicated because of the Oncotype score.

For HRRm prostate cancer, will you use olaparib alone or in combination with abiraterone?

What is your process for assessing the "high risk" clinical features in gBRCA+ breast cancer in order to offer olaparib, given varying definitions of risk and recent changes in staging guidelines?

Definitions for "high risk" differ by whether patients receive neoadjuvant chemo and across other contemporary studies. Does the change in AJCC stagin...

Will you offer adjuvant olaparib to patients with somatic BRCA mutated breast cancer given that OlympiA only enrolled germline BRCA+?

Do you perceive a difference between somatic vs germline BRCA mutations?

If you have a high risk HR+, BRCA+ breast cancer patient who qualifies for adjuvant olaparib and abemaciclib, which one would you give and why?

Would you ever consider using these in sequence?

Would you consider adjuvant olaparib in a patient with HER2+, high-risk, early stage breast cancer with germline BRCA mutation?

OlympiA trial did not include her2+ breast cancer.

Would you recommend adjuvant olaparib in a premenopausal BRCA1+ woman with stage IA pT1bN0 ER/PR+ HER2- breast cancer and a high OncoType score?

The OncotypeDx score was 51 in this scenario.

What is your preferred adjuvant therapy for a patient with triple negative breast cancer and has a BRCA germline mutation who had minimal to no response to neoadjuvant chemotherapy?

Young patient, germline BRCA carrier with cT1cN0 to ypT2N0 disease after docetaxel/ cyclophosphamide x 4.

Given recent OS data from the OlympiA trial, would you offer adjuvant olaparib to a BRCA+ patient with pT1bN0 TNBC?

Ref: Geyer et al, Overall survival in the OlympiA phase III trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1/2 and hi...

Do you plan to offer adjuvant olaparib to all gBRCA+ breast cancer whether TNBC or HR+?

In subset analyses of OlympiA there seems to be smaller magnitude of benefit among HR+ patients. In your opinion, should adjuvant olabarib be offered ...

In patients who receive neoadjuvant pembrolizumab and chemotherapy for TNBC, how will you manage adjuvant treatment if they have a germline BRCA mutation?

Would you continue pembrolizumab? Would you introduce olaparib? If using both, how would you sequence?

How do you sequence capecitabine and olaparib, if at all, in patients with BRCA+ TNBC and residual disease after neoadjuvant chemotherapy?

Would you consider hormone replacement therapy in young women with germline BRCA1 mutation and history of triple negative breast cancer who underwent bilateral mastectomy and prophylactic bilateral salpingo-oophorectomy?

This situation can feel uncomfortable. Would this feel safer if patient is s/p mastectomy and had TNBC?

What is the optimal sequence of systemic therapy for a patient with HR+, gBRCA mutated metastatic breast cancer?

How do you counsel premenopausal women with BRCA1 or BRCA2 mutations on the need for bilateral oopherectomy?

Are there any clinical scenarios in which you would treat BRCA mutated HER2 negative metastatic breast cancer with a PARP inhibitor in combination with carboplatin?

Do any studies support this rationale? Does the presence of a somatic vs germline BRCA mutation impact your decision?

What factors impact your decision to include bevacizumab with primary chemotherapy for patients with BRCA+ or HRD+ ovarian cancer?

Does your practice vary based on risk status (low vs high risk) or specific mutation status (BRCA+ vs HRD+) given PAOLA subset analyses?

Which PARP inhibitor do you recommend for maintenance therapy in BRCA+ ovarian cancer after primary chemotherapy and why?

How do the 5 year results of SOLO-1 at ESMO 2020 impact your recommendations?

How do you advise patients on duration of first line maintenance PARPi and the potential risk of MDS or AML?

Is MDS/AML risk increased with longer duration of therapy? Does your approach differ for patients who are BRCA+/HRD vs wild type/HRP?