Would you consider adjuvant treatment for a premenopausal oligometastatic TNBC with gBRCA2 pv mutation who is now NED and had received prior KN522 with pCR and surgery/consolidative RT to solitary brain mets?

Based on experience from the NRG-BR002 trial, local therapy for oligometastatic disease is not associated with improved PFS or OS. Furthermore, there are retrospective studies that show improved survival of patients with brain-only metastases who were treated with systemic therapy following definiti...

I would classify this scenario as not adjuvant or pseudo-adjuvant therapy but rather as stage IV (recurrent oligometastatic) disease rendered NED, which changes the evidentiary framing. The early-stage adjuvant trials that make olaparib, capecitabine, and pembrolizumab "standard" (OlympiA, CREATE-X,...

My assumption is that the patient has no evidence of local or distant recurrence except in the brain. My recommendation would be initiation of 'maintenance' therapy with olaparib 300 mg BID (or whatever dose the patient can tolerate - given her prior chemo, it would not be unreasonable to start at d...