Would you consider adjuvant olaparib in a patient with HER2+, high-risk, early stage breast cancer with germline BRCA mutation?

We do not yet know whether HER2 amplified cancers in women with BRCA mutations are in fact driven by HER2. However, given the remarkable efficacy of anti-HER2 therapy, I would be loath to discard the accepted strategies for managing HER2-positive disease. There is also a pragmatic challenge which is...

No, considering that the OlympiA trial did not include these patients; I would manage this patient as those with HER2-positive disease (so T-DM1 if no pCR after neoadjuvant treatment, or chemotherapy plus dual anti-HER2 blockade trastuzumab and pertuzumab if adjuvant treatment).

Agree with Dr. @Dr. First Last - given the excellent outcomes with standard (neo) adjuvant chemotherapy and dual HER2-targeted therapy, even in high-risk patients (I strongly favor treatment in the neoadjuvant setting in such patients, in part to identify patients who might benefit from adjuvant T-D...