At what time do you switch to olaparib after FOLFIRINOX in BRCA mutated metastatic pancreatic adenocarcinoma patients?

Based on POLO - an individual with germline BRCA+ PDAC had to have at least 16 weeks of platinum based therapy (majority had (m)FOLFIRINOX, small # cisplatin/gemcitabine) - before randomization to olaparib or placebo (Golan et alm NEJM, 2019). So, based on the data - this option is there to consider switching to olaparib maintenance after 4 months. Continuing systemic therapy including FOLFIRI or infusional 5-FU/LV as maintenance treatment is certainly an option too especially if a patient is tolerating therapy well. A key point to keep in mind is that multiple data sets do not suggest a benefit to PARP inhibitors in a platinum refractory setting. Thus, my preference is to integrate olaparib once treatment response has maximized and when cu...

Based on POLO trial after you have given 6 months of FOLFIRINOX if they do not have progressive disease you can start on Olaparib.

2nd line