Cited by 1,655PARP inhibition in cancer therapyBRCA gene mutations in cancerAdvanced Breast Cancer Therapies

Oral poly(ADP-ribose) polymerase inhibitor olaparib in patients with BRCA1 or BRCA2 mutations and advanced breast cancer: a proof-of-concept trial

Tutt, Andrew, Robson, Mark, Garber, Judy E, Domchek, Susan M, Audeh, M William, Weitzel, Jeffrey N, Friedlander, Michael, Arun, Banu +7 more·2010·The Lancet

Abstract

Background Olaparib, a novel, orally active poly(ADP-ribose) polymerase (PARP) inhibitor, induced synthetic lethality in BRCA-deficient cells. A maximum tolerated dose and initial signal of efficacy in BRCA-deficient ovarian cancers have been reported. We therefore assessed the efficacy, safety, and tolerability of olaparib alone in women with BRCA1 or BRCA2 mutations and advanced breast cancer.Methods Women (aged >or=18 years) with confirmed BRCA1 or BRCA2 mutations and recurrent, advanced breast cancer were assigned to two sequential cohorts in a phase 2 study undertaken in 16 centres in Australia, Germany, Spain, Sweden, the UK, and the USA. The first cohort (n=27) was given continuous oral olaparib at the maximum tolerated dose (400 mg twice daily), and the second (n=27) was given a lower dose (100 mg twice daily). The primary efficacy endpoint was objective response rate (ORR). This study is registered with ClinicalTrials.gov, number NCT00494234.Findings Patients had been given a median of three previous chemotherapy regimens (range 1-5 in cohort 1, and 2-4 in cohort 2). ORR was 11 (41%) of 27 patients (95% CI 25-59) in the cohort assigned to 400 mg twice daily, and six (22%) of 27 (11-41) in the cohort assigned to 100 mg twice daily. Toxicities were mainly at low grades. The most frequent causally related adverse events in the cohort given 400 mg twice daily were fatigue (grade 1 or 2, 11 [41%]; grade 3 or 4, four [15%]), nausea (grade 1 or 2, 11 [41%]; grade 3 or 4, four [15%]), vomiting (grade 1 or 2, three [11%]; grade 3 or 4, three [11%]), and anaemia (grade 1 or 2, one [4%]; grade 3 or 4, three [11%]). The most frequent causally related adverse events in the cohort given 100 mg twice daily were nausea (grade 1 or 2, 11 [41%]; none grade 3 or 4) and fatigue (grade 1 or 2, seven [26%]; grade 3 or 4, one [4%]).Interpretation The results of this study provide positive proof of concept for PARP inhibition in BRCA-deficient breast cancers and shows a favourable therapeutic index for a novel targeted treatment strategy in patients with tumours that have genetic loss of function of BRCA1-associated or BRCA2-associated DNA repair. Toxicity in women with BRCA1 and BRCA2 mutations was similar to that reported previously in those without such mutations.Funding AstraZeneca.

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Crossref · 10.1016/s0140-6736(10)60892-6

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Authors
Tutt, A., Robson, M., Garber, J. E., Domchek, S. M., Audeh, M. W., Weitzel, J. N., Friedlander, M., Arun, B., Loman, N., Schmutzler, R. K., Wardley, A., Mitchell, G., Earl, H., Wickens, M., & Carmichael, J.
Affiliations
  • Guy's Hospital (GB)
  • Memorial Sloan Kettering Cancer Center (US)
  • Dana-Farber Cancer Institute (US)
  • Abramson Cancer Center (US)
  • Cedars-Sinai Medical Center (US)
  • City Of Hope National Medical Center (US)
  • The University of Texas MD Anderson Cancer Center (US)
  • Lund University (SE)
  • University of Cologne (DE)
  • The Christie Hospital (GB)
  • Peter MacCallum Cancer Centre (AU)
  • University of Cambridge (GB)
  • AstraZeneca (United Kingdom) (GB)
Corresponding author
Tutt, Andrew
Venue
The Lancet
Publisher
Elsevier BV
Published
2010-07
Volume
376
Issue
9737
Pages
235-244
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
OpenAlex
W3093265161
Cited by
1,655
References
41
Citations by year
2026: 22 · 2025: 41 · 2024: 41 · 2023: 51 · 2022: 64 · 2021: 66 · 2020: 106 · 2019: 97 · 2018: 120 · 2017: 150 · 2016: 147 · 2015: 139 · 2014: 133 · 2013: 129 · 2012: 143
FWCI
75.63
Type
journal article
Language
en
Open access
closed
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion)
  • Lund University Publications (Lund University) (submittedVersion)
Funders
  • AstraZeneca
  • Cancer Research Society
  • Susan G. Komen
Topics
  • Health Sciences › Medicine › Oncology › PARP inhibition in cancer therapy
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › BRCA gene mutations in cancer
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Advanced Breast Cancer Therapies
Keywords
olaparib, PARP inhibitors, BRCA1 mutation, BRCA2 mutation, advanced breast cancer, synthetic lethality, objective response rate, dose escalation, adverse events, tolerability, germline mutation carriers, targeted therapy, maximum tolerated dose, anemia, fatigue, nausea and vomiting
MeSH terms
Poly(ADP-ribose) Polymerase Inhibitors, Adult, Aged, Antineoplastic Agents, Breast Neoplasms, Female, Humans, Middle Aged, Phthalazines, Piperazines, Prospective Studies, Germ-Line Mutation, Genes, BRCA1, Maximum Tolerated Dose, Genes, BRCA2

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