7
Recommendation 10 – ASCO Recommendation Update June 2021
➤ For patients with early-stage, HER2–negative breast cancer with high
risk of recurrence and germline BRCA1 or BRCA2 pathogenic or likely
pathogenic variants, one year of adjuvant olaparib should be offered
after completion of (neo)adjuvant chemotherapy and local treatment,
including radiation.
• For those who had surgery first, one year of adjuvant olaparib should be offered
for patients with triple negative breast cancer (TNBC) and tumor size >2 cm or
any involved axillary nodes.
• For those with hormone receptor-positive disease, one year of adjuvant olaparib
should be offered to those with at least four involved axillary lymph nodes.
• For patients who had neoadjuvant chemotherapy, one year of adjuvant olaparib
should be offered to patients with TNBC and any residual cancer; for patients
with hormone receptor-positive disease, one year of adjuvant olaparib should
be offered to patients with residual disease and a clinical stage, pathologic stage,
estrogen receptor status, and tumor grade (CSP+EG) score ≥3.
Table 1. Management of Hereditary Breast Cancer in
BRCA1/2 vs. Moderate Penetrance Genes
Women with Breast Cancer Who Have a BRCA1 or BRCA2 Mutation
Local Therapy Recommendations
Index/Current Cancer
Germline BRCA status should not preclude a patient with newly diagnosed breast
cancer otherwise eligible for breast conserving therapy (BCT) from receiving BCT.
Surgical management of the index malignancy (BCT vs. ipsilateral therapeutic and
contralateral risk-reducing mastectomy) in BRCA1/2 mutation carriers should be
discussed, considering the increased risk of contralateral breast cancer and possible
increased risk of an ipsilateral new primary breast cancer compared to non-carriers.
For women with newly diagnosed breast cancer undergoing mastectomy who have a
deleterious mutation in BRCA 1 or 2, or moderate-penetrance genes, nipple-sparing
mastectomy is a reasonable oncologic approach to consider in appropriately selected
patients.
For women with breast cancer who are treated with BCT or with mastectomy for whom
post-mastectomy radiotherapy is considered, radiation therapy should not be withheld
due to mutation status, except for mutations in TP53 (see Recommendation 6.3 that
states that radiotherapy of the intact breast is contraindicated in TP53 carriers). ere
is no evidence of a significant increase in toxicity or contralateral breast cancers (CBC)
related to radiation exposure among patients with a mutation in a BRCA1/2 or a
moderate-penetrance gene.
