What is your process for assessing the "high risk" clinical features in gBRCA+ breast cancer in order to offer olaparib, given varying definitions of risk and recent changes in staging guidelines?

I follow the criteria used in the eligibility for the OlympiA trial to determine who I will offer olaparib to in the adjuvant setting, which is consistent with the ASCO Hereditary Breast Cancer Guideline Rapid Recommendation Update.

In patients with gBRCA+ breast cancer who received at least 6 cycles...

I would use the eligibility criteria used in OlympiA study for HR positive patients.

The definition of high risk clinical features varies across clinical trials. Most patients with triple negative breast cancers are considered high risk for recurrence and hence chemotherapy is usually indicated. Among hormone receptor positive breast cancer, patients with high genomic risk, high Ki-...