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

Patients with germline PV in BRCA 1/2 and residual disease following NAC in early TNBC have two options that likely represent standard of care in the adjuvant setting, a) adjuvant capecitabine (CREATE-X, EA1131) and/or b) adjuvant olaparib (NSABP B55). B55 did not allow for any further adjuvant chem...

In general, I agree with Dr. @Sagar D. Sardesai. This will be a tough scenario, without data to guide our choice of therapy. In the OlympiA trial, patients enrolled within 12 weeks of completing their other adjuvant therapy, so you could imagine that it might be reasonable in a patient with signific...

Great question. At this time, we have no data related to using both in the adjuvant setting. A practical approach would be to go with the data, if a patient has TNBC and a germline BRCA mutation with a non-pCR; she would be eligible for Olaparib as per the OlympiA trial.

"Should the preferred adjuvant agent be olaparib or capecitabine or sequential use for germline BRCA1/2 mutated TNBC with residual disease after neoadjuvant chemotherapy?" Results for CREATE-X according to gBRCA1/2 status are not available, but it is presumed that approximately 15% of patients with ...

The CREATE-X study demonstrated the efficacy of adjuvant capecitabine in patients with triple negative breast cancer who did not achieve pathologic complete remission with neoadjuvant chemotherapy. On the other hand, adjuvant olaparib significantly improved outcomes in patients with germline BRCA mu...