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Treatment of BRCA 1 mutated breast cancer with a PARP inhibitor and an Immune Checkpoint Inhibitor

Christina Hoppe1, Kiera Roubal1, Sushma Pavuluri2

  • 1Clinical Pharmacy Specialist - Hematology & Oncology, Medical University of South Carolina, Charleston, SC, USA.

Journal of Oncology Pharmacy Practice : Official Publication of the International Society of Oncology Pharmacy Practitioners
|February 18, 2025
PubMed

Insights

This case study shows successful treatment of BRCA1-mutated triple-negative breast cancer (TNBC) using pembrolizumab after olaparib therapy. This sequential approach offers a potential new strategy for managing advanced TNBC.

Area of Science:

  • Oncology
  • Medical Genetics
  • Immunotherapy

Background:

  • Triple-negative breast cancer (TNBC) lacks hormone receptors (HR) and HER2, making treatment challenging.
  • Germline BRCA mutations and specific biomarkers like PD-L1 influence treatment selection.
  • Advances include PARP inhibitors (e.g., olaparib) and immune checkpoint inhibitors for TNBC.

Purpose of the Study:

  • To present a case of successful sequential treatment in a patient with BRCA1-mutated TNBC and ovarian cancer.
  • To evaluate the efficacy of immunotherapy (pembrolizumab) following PARP inhibitor (olaparib) therapy.
  • To contribute to limited data on sequential immunotherapy use after PARP inhibitors.

Main Methods:

  • A patient with BRCA1-mutated TNBC and ovarian cancer received olaparib, followed by chemotherapy and pembrolizumab.
  • Treatment involved gemcitabine, carboplatin, and pembrolizumab, followed by pembrolizumab maintenance.
  • Subsequent treatments included carboplatin, paclitaxel, bevacizumab, and finally olaparib with bevacizumab.

Main Results:

  • Initial combination therapy with pembrolizumab led to resolution of brain metastases.
  • Pembrolizumab maintenance was continued, demonstrating sustained response.
  • The patient showed tolerance and response to sequential treatment regimens.

Conclusions:

  • Sequential use of immunotherapy after PARP inhibitor treatment can be effective.
  • This case highlights a potential treatment strategy for BRCA1-mutated TNBC.
  • Further research is needed to validate immunotherapy use following PARP inhibitors.
Keywords:
BRCA mutationPARP inhibitorTriple negative breast cancerimmune checkpoint inhibitorsequential therapy

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