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ASCO 2021 round-up

Priscilla Lynch presents a round-up of some of the most topical research presented at this year’s ASCO Annual Meeting

ASCO rapid guideline update for HER2-negative breast cancer

Anew American Society of Clinical Oncology (ASCO) guideline update recommends offering one year of adjuvant olaparib to patients with high-risk early-stage human epidermal growth factor receptor 2 (HER2)-negative breast cancer and germline BRCA mutations after completion of (neo)adjuvant chemotherapy and local treatment, including radiation.

For those who had surgery first, adjuvant olaparib is recommended for patients with TNBC and tumour size >2cm or any involved axillary nodes. For patients with hormone receptor-positive disease, adjuvant olaparib is recommended for those with at least four involved axillary lymph nodes. For patients who had neoadjuvant chemotherapy, adjuvant olaparib is recommended for patients with TNBC and any residual cancer. Adjuvant olaparib is recommended for patients with residual disease and an oestrogen receptor status and tumour grade (CSP+EG) score ≥3.

The recommendations update the 2020 guideline from ASCO, the American Society for Radiation Oncology (ASTRO),
and the Society of Surgical Oncology (SSO) on the management of hereditary breast cancer. This recommendation update incorporates evidence from the OlympiA randomised controlled trial following presentation at the 2021 ASCO Annual Meeting and publication in the New England Journal of Medicine on June 3, 2021.

“Guideline updates have traditionally required months to review new data, assemble an expert panel, develop, approve, and publish recommendations – making it difficult to provide timely support to clinicians seeking to keep abreast of rapidly advancing research. ASCO’s new rapid guideline updating strategy is meant to address this need by providing rapid evidence review and dissemination of practice-changing trial results,” said ASCO Chief Executive Officer, Dr Clifford A Hudis.

OlympiA trial authors reported a significant improvement in invasive and distant disease-free survival with adjuvant use of the poly (adenosine diphosphate–ribose) polymerase (PARP) inhibitor olaparib compared with placebo in patients with early-stage, HER2–negative breast cancer with high risk of recurrence and germline BRCA1 or BRCA2 pathogenic or likely pathogenic variants. Patients who received standard treatment plus placebo had an estimated three-year improved invasive disease-free survival (IDFS) of 77.1 per cent.

With the additional administration of one year of the oral PARP inhibitor olaparib, the estimated three-year IDFS was improved to 85.9 per cent. The estimated three-year distant disease-free survival was also improved from 80.4 per cent with placebo to 87.5 per cent with olaparib. These clear and positive data prompted ASCO to issue a provisional update of the guideline recommendation focused specifically on the role of olaparib in this setting.

“The findings from the OlympiA trial – presented just last week – mark a significant improvement in the care of these patients. ASCO’s Expert Guideline Panel and Evidence-based Medicine Committee noted this and then quickly produced and provisionally approved this guideline update to enable patients to begin to benefit from this research advance as quickly as possible,” said Dr Julie Gralow, ASCO Executive Vice President and Chief Medical Officer.

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