OLYMPIA

In this video, Prof Dr François Duhoux and Dr Elisa Agostinetto analyse the data of the OlympiA study that was presented during General Session 1 at SABCS 2024.

The OlympiA trial was a randomised phase 3 clinical trial that included patients with germline BRCA mutations and high-risk HER2-negative early breast cancer. These patients were randomised in the adjuvant setting to receive one year of olaparib, a PARP inhibitor, or a placebo. The trial included patients with either triple-negative or hormone receptor-positive HER2-negative breast cancer. Initial results published in the New England Journal of Medicine showed a significant improvement in survival for patients receiving olaparib. At this year’s San Antonio Breast Cancer Symposium, updated results were presented, reflecting 10 years since the trial’s initiation and a median follow-up of 6.1 years. These results showed a 9% improvement in invasive disease-free survival, demonstrating a sustained benefit of olaparib.

The benefit was consistent across all subgroups, including triple-negative and hormone receptor-positive populations. Improvements were also observed in distant disease-free survival and overall survival, with a 5% absolute gain in overall survival. These findings emphasise the importance of BRCA testing at diagnosis to identify patients who may benefit from this treatment.

Regarding safety, there were no new signals for concerns such as AML, MDS, or secondary malignancies, and fertility outcomes were reassuring. The number of pregnancies was similar between the olaparib and placebo groups, which is significant for the younger population often affected by germline BRCA mutations. Another key finding was the reduction in distant recurrences and primary cancers, including ovarian cancer, in patients treated with olaparib.

A major discussion point is how to integrate olaparib with immune checkpoint inhibitors such as pembrolizumab, particularly for triple-negative patients who fail to achieve a pathological complete response after neoadjuvant therapy. While some centers may combine these therapies, others may need to choose between them due to resource constraints. In such cases, the evidence from OlympiA supports prioritising olaparib for BRCA-mutated patients, given its substantial survival benefits.

These results reaffirm olaparib’s critical role in improving outcomes for patients with BRCA mutations, making it a key component of the treatment strategy in this population. The trial has reshaped clinical practice, and ongoing studies will help address questions about optimal treatment combinations in the future..