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

In a patient with a gBRCAm that is PDL1+, I generally consider chemotherapy + checkpoint inhibition in the first line setting given the known survival benefit upfront, and since it is unknown if this benefit with chemotherapy + immunotherapy would be seen in the later line setting. We do have data t...

We updated the NCCN breast guidelines with a new section for metastatic TNBC. The guidelines place a preference to do pembrolizumab in a CPS>=10 patient first regardless of their BRCA status. If I knew they were BRCA1 mutated and CPS over 9, I would probably prioritize using carbo/gem plus pembroliz...

I would have treated a patient with gBRCA+ TNBC with a regimen that includes a platinum agent in the neoadjuvant setting.

With current FDA approval for olaparib in the adjuvant setting, this is a patient who now could have been treated with neoadjuvant ddAC/T followed by adjuvant olaparib for failur...

I tend to consider immunotherapy first if PD-L1 CPS>=10, unless toxicity is a major issue in a particular patient. In that case, PARPi would be my first choice.