DR RUGO: Most of our data really come from — in terms of the single agent, the olaparib study that showed that the higher dose worked better and that you would get some response in pretreated patients with BRCA1- and BRCA2-associated advanced malignancy, data published in the New England Journal. The development of PARP inhibitors was really hurt a lot by the iniparib story and by some, I think, hesitation on the part of the companies to move forward. So that’s really a shame, because it’s really unbelievable that we don’t have a PARP inhibitor approved in breast cancer yet.

There is a lot of work going on in the OlympiAD in metastatic disease and the OlympiA trial comparing to either treatment of physician choice or placebo with olaparib. And then there are a number of other studies going on with other PARP inhibitors. So veliparib has just completed accrual to a randomized Phase III neoadjuvant trial called the Brightness trial, based on our I-SPY data that I presented before, looking at either carboplatin with paclitaxel, veliparib and carboplatin or paclitaxel alone.

So it’s a 3-arm study looking at a primary endpoint of pathologic complete response. And I think the beauty of that study is that it’s not just in BRCA mutants. We will check for BRCA mutations, but it’s in all comers with triple-negative disease. We also have seen very interesting data from talazoparib, which is a novel PARP inhibitor that tracks PARP. And so that works a little bit differently than veliparib and olaparib and niraparib.

And that agent is being tested in the Phase III EMBRACA trial, which is for patients who haven’t progressed on a prior platinum, and randomizes to that agent, talazoparib, versus chemotherapy of physician’s choice. And actually, I have a patient who’s now been on it for ER-positive, BRCA-positive disease with a longer response than she got to hormone therapy in the metastatic setting. And this is a patient who relapsed on adjuvant hormone therapy in bone. So clearly, we can see efficacy. The talazoparib, like olaparib, results in bone marrow suppression, so you’re kind of jumping around all the time with dose. But I think they clearly have efficacy in patients with BRCA mutations. I’m hoping we can prove that.

And I think probably the best 2 trials in the metastatic setting are OlympiAD and the EMBRACA trial with talazoparib and then the adjuvant OlympiA trial in high-risk patients. In the patients who have sporadic triple-negative disease, the neoadjuvant Brightness trial is incredibly important for us following the TNT data that suggested that response to platinum over docetaxel as first-line treatment in the metastatic setting was really an indicator that you had a BRCA mutation rather than anything else.

And so what we need to understand is, who are the patients who benefit? And this neoadjuvant trial, I think, will give us a huge amount of information. And it’s cool, because there are a lot of international people involved in the management of the trial and in the management of the biospecimens that are being collected.

Genomic assays and (neo)adjuvant treatment decision-making

Early-stage breast cancer in the adjuvant and neoadjuvant settings

Management of metastatic breast cancer (mBC)

CDK4/6 inhibitors for the treatment of breast cancer

Checkpoint inhibitors and other novel immunotherapeutic approaches to breast cancer

Triple-negative and BRCA mutation-positive breast cancers