In women with the “Jolie” mutation, the targeted drug olaparib, already approved for metastatic breast cancer, demonstrates important survival benefits even for the early stages of the disease. From the virtual plenary session of the European Society of Medical Oncology (ESMO), the new data from the OlympiA study confirm this: olaparib as an adjuvant treatment (i.e. after surgery) has been shown to bring a statistically significant improvement in overall survival compared to placebo, in patients with BRCA germline mutation and early-stage high-risk (HER2-negative) breast cancer, already treated with chemotherapy.
What does “high risk” mean
“The latest results of the OlympiA study are excellent news for patients with a specific inherited form of breast cancer, and confirm that a real revolution is underway in the treatment of this disease, based on increasingly targeted and effective treatments”, explains Michelino De Laurentiis, Director of the Senology Department of the Pascale Cancer Institute in Naples and Principal Investigator of the OlympiA study for Italy. Specifically, the results refer to hereditary breast cancers, arising in women with mutations in one or both of two specific genes called BRCA1 and BRCA2. Most of these cancers, when identified early, heal. Not all of them, however, and some of them have a higher risk of recurring. “The OlympiA study – continues the expert – has now shown that, in these cases, it is possible to use olaparib to further reduce the risk of relapse and increase the chances of definitive recovery”.
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The Olympia study
The OlympiA study was conducted by the Breast International Group (BIG) in collaboration with the Frontier Science & Technology Research Foundation, NRG Oncology, AstraZeneca and MSD. More specifically, the data show that olaparib reduced the risk of death by 32% compared to placebo. The three-year survival rate was 92.8% versus 89.1%, while at four years it was 89.8% versus 86.4%. It is the first drug of the class of PARP inhibitors to demonstrate an overall survival benefit in early stage breast cancer and on the basis of the results of this study, the US regulatory agency, the FDA, has recently approved olaparib also for initial breast cancer in BRCA-mutated patients.
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The importance of genetic testing
Being able to access genetic tests for Brca mutations now becomes even more important, because knowing if you have the mutation is no longer important only to implement individual and family prevention strategies, but will allow you to customize the treatment even more. “It is essential that all patients with triple negative neoplasia carry out the BRCA test at the time of diagnosis since, in case of failure to fully respond to neoadjuvant chemotherapy or in the presence of tumors greater than two cm or with at least one positive lymph node, the mutation genetics will allow you to perform a maintenance treatment with a real survival advantage “underlines Laura Cortesi, Head of the Oncological Genetics Structure at the Department of Oncology of the University Hospital of Modena:” Even in patients affected by tumors with hormone receptors positive, occurring within 35 years of age, or with previous ovarian neoplasms or strong familiarity, it may be useful to perform the BRCA test for therapeutic purposes, if at least four affected lymph nodes are present or there is no complete pathological response to neoadjuvant therapy “.
Breast Health
Breast cancer and BRCA mutation: too many differences in health from region to region
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In Italy it is estimated that, in 2020, 55,000 women received a diagnosis of breast cancer and the presence of a BRCA germline mutation is detected in about 5% of patients. The genetic test is performed on blood and can be prescribed by the oncologist or geneticist, who are also responsible for informing the patient.