How strict are you about adhering to the eligibility criteria required for entry onto the OlympiA trial in considering a year of adjuvant olaparib as adjuvant therapy for BRCA mutated, node positive, ER positive breast cancer?

When considering PARP inhibitors or CDK4/6 inhibitors in the adjuvant setting, we follow the criteria used for the trials. This is because the trials dictated what is now in the guidelines and the guidelines dictate what insurance will cover.

I do offer adjuvant olaparib for patients with ER+ HER2-neg breast cancer beyond the eligibility in OlympiA. The bar for enrollment was very high for BRCA carriers with ER+ disease. So if a patient has 1-3 positive nodes, I do discuss and weigh other clinical factors.