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Article Details
Clinical Image
Volume 5, Issue 3 (March Issue)

Olaparib in Breast Cancer

Samragnyi Madala1 and Sneha Phadke2*

1Division of Hematology and Oncology, University of Iowa Hospitals and Clinics, 200 Hawkins drive, Iowa City, IA

2Division of Breast Medical Oncology, University of Iowa, Carver College of Medicine, 375 Newton Rd, Iowa City, IA

*Corresponding author: Sneha Phadke, Division of Breast Medical Oncology, University of Iowa, Carver College of Medicine, Iowa City, IA. E-mail:

Received: January 15, 2023; Accepted: January 24, 2023; Published: February 15, 2023

Citation: Madala S, Phadke S. Olaparib in Breast Cancer. Clin Image Case Rep J. 2023; 5(2): 303.

Olaparib in Breast Cancer

A 71-year-old female presents with a 6-month history of an enlarging left breast mass. She has a history of right breast and ovarian cancers treated at the ages of 38 and 59, respectively, and a germline mutation in breast cancer susceptibility gene 1 (BRCA1). On examination, a large fungating left breast mass was seen (Panel A). Biopsy showed poorly differentiated triple negative adenocarcinoma of the left breast, programmed cell death ligand 1 (PDL1) negative (combined positive score less than 1). Systemic staging showed local invasion into the left side of the sternum, left second rib with axillary lymphadenopathy and multiple bilateral pulmonary metastasis. Treatment was initiated with single agent nab-paclitaxel, and pembrolizumab was subsequently added when a high Tumor Mutation Burden was discovered on genomic testing of the tumor. She achieved partial response. Upon clinical progression of the fungating mass, she was started on the poly (ADP-ribose) polymerase (PARP) inhibitor olaparib with a robust response within 3 weeks. There was a remarkable improvement in the size of the breast tumor by 8 weeks (Panel B) and 20 weeks (Panel C). Repeat imaging showed regression in the pulmonary metastatic lesions with a stable sternal lytic lesion. In breast cancer patients with a germline BRCA mutation, PARP inhibitors can result in an extraordinary response and should be considered even in patients needing a quick response due to symptomatic or heavy disease burden. Eight months after starting olaparib, our patient continues to have stable disease.