If you have a high risk HR+, BRCA+ breast cancer patient who qualifies for adjuvant olaparib and abemaciclib, which one would you give and why?

The results of the recent OympiA trial published in the New England Journal of Medicine by Tutt et al. for women with high risk BRCA positive breast cancer, together with the MonarchE trial for high-risk ER positive breast cancer, has created somewhat of a dilemma as to which therapy to add to patie...

There was very new data that was discussed in SABCS 2021, suggesting that BRCA2 deficient tumors may not respond well to the CDK4/6 inhibitor. Of course, while a prospective study is required, biologically, it may make more sense to offer olaparib over abemaciclib.

Safonov et al., AACR 2022 Abstract...

Unfortunately, this is a situation where we have limited data. It is not clear whether one drug is better than the other or whether the drugs should be given in combination or sequentially. I would discuss the options with the patient and discuss side effects and monitoring plan. Given that the brea...

This is an interesting question for which there is no data, so there will be no "correct" answer. For both agents, large, prospective randomized trials show benefit in terms of disease free survival.

The study of adjuvant olaparib included 1,836 patients with germline BRCA1 or BRCA2 mutations and hi...