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OlympiAD was the first trial to show a PARP inhibitor tablet beats chemotherapy in breast cancer, delaying progression by about three months in women with an inherited BRCA mutation and with fewer side effects, though it did not lengthen life overall.
OlympiAD, trial NCT02000622 sponsored by AstraZeneca and published in the New England Journal of Medicine in 2017, randomised 302 patients with a germline BRCA1 or BRCA2 mutation and HER2-negative metastatic breast cancer, about half triple-negative, to olaparib tablets or the physician's choice of capecitabine, eribulin or vinorelbine. Progression-free survival rose from 4.2 to 7.0 months (hazard ratio 0.58), the response rate doubled and severe side effects were less common with olaparib; overall survival was 19.3 against 17.1 months and not significantly different, with a suggestion of benefit in patients who had not had chemotherapy for metastatic disease. It led to the January 2018 approval of olaparib, the first PARP inhibitor for breast cancer, and made germline testing a treatment decision in metastatic disease. Whether PARP inhibition should come before or after platinum, to which it shares a mechanism of resistance, is the open question.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
302 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Progression-free survivalprimary | Olaparib | 205 | 7 months | 0.58 (0.43 to 0.8) | <0.001 | link |
| Chemotherapy | 97 | 4.2 months | ||||
| Overall survival | Olaparib | - | 19.3 months | 0.9 (0.66 to 1.23) | - | link |
| Chemotherapy | - | 17.1 months |
The document that made immunotherapy, PARP inhibition and the first antibody-drug conjugate the European standard for metastatic triple-negative disease; every later first-line change is an amendment to it.
Sets the surgical and systemic rules for the one in nine to one in six triple-negative patients who carry a germline BRCA variant (11 to 17 percent by cohort); the adjuvant gap it named was filled by OlympiA the following year.
A second publication from the OlympiAD trial, later than the first and described in its title as an update or longer-term analysis. Read it with the primary publication linked from the trial page; the record was linked automatically and its figures have not been checked by hand.
Germline BRCA testing became part of metastatic breast cancer work-up, and olaparib (with talazoparib after EMBRACA) is a standard option, especially for triple-negative disease.
Shares ESMO Clinical Practice Guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer, BROCADE3, Management of Hereditary Breast Cancer: American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Guideline, BRCA-associated triple-negative breast cancer.
Shares BROCADE3, PARP, PARP inhibitors, BRCA1 / BRCA2 (HRD).
Shares OlympiAD: olaparib versus chemotherapy in metastatic breast cancer with a germline BRCA mutation, Management of Hereditary Breast Cancer: American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Guideline, Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem, Metastatic triple-negative breast cancer.
Shares PARP, PARP inhibitors, BRCA1 / BRCA2 (HRD), Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem.
Shares TNT (Triple Negative Trial), PARP, PARP inhibitors, Olaparib.
Shares PARP inhibitors, Olaparib, BRCA1 / BRCA2 (HRD), Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem.
Shares Management of Hereditary Breast Cancer: American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Guideline, BRCA-associated triple-negative breast cancer, Germline BRCA mutation (gBRCA), PARP inhibitors.
Shares PARP inhibitors, Olaparib, BRCA1 / BRCA2 (HRD), Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem.