Olaparib in Treating Patients with Triple-Negative Non-metastatic Breast Cancer Who Have Completed Definitive Local Treatment and Chemotherapy

Inclusion Criteria

• Provision of informed consent prior to any study specific procedures
• * For patients who underwent initial surgery and received adjuvant chemotherapy ** Triple negative breast cancer (TNBC) patients must have been axillary node-positive (>= pN1, any tumor size) or axillary node negative (pN0) with invasive primary tumor pathological size > 2 cm (>= pT2) ** Estrogen receptor (ER) and/or progesterone receptor (PgR) positive/human epidermal growth factor receptor (HER) 2 negative patients must have had >= 4 pathologically confirmed positive lymph nodes * For patients who underwent neoadjuvant chemotherapy followed by surgery ** TNBC patients must have residual invasive breast cancer in the breast and/or resected lymph nodes (non-pathological complete response [pCR]) ** ER and/or PgR positive/HER2 negative patients must have residual invasive cancer in the breast and/or the resected lymph nodes (non-pCR) AND a clinical pathologic stage (CPS) & estrogen receptor status nuclear grade (EG) score >= 3
• Histologically confirmed non-metastatic primary invasive adenocarcinoma of the breast that is one of the two following phenotypes: * TNBC defined as: ** ER and PgR negative defined as immunohistochemistry (IHC) nuclear staining < 1% AND ** HER2 negative (not eligible for anti-HER2 therapy) defined as: *** IHC 0, 1+ without in situ hybridization (ISH) OR *** IHC 2+ and ISH non-amplified with ratio less than 2.0 and if reported, average HER2 copy number < 4 signals/cells OR *** ISH non-amplified with ratio less than 2.0 and if reported, average HER2 copy number < 4 signals/cells (without IHC) * ER and/or PgR positive, HER2 negative breast cancer defined as: ** ER and/or PgR positive defined as IHC nuclear staining >= 1%; AND ** HER2 negative (not eligible for anti-HER2 therapy) defined as: *** IHC 0, 1+ without ISH OR *** IHC 2+ and ISH non-amplified with ratio less than 2.0 and if reported, average HER2 copy number < 4 signals/cells OR *** ISH non-amplified with ratio less than 2.0 and if reported, average HER2 copy number < 4 signals/cells (without IHC)
• Patients with multifocal or multicentric invasive disease are eligible as long as all the lesions for which HER2 characterization is available are HER2 negative
• Patients with synchronous bilateral invasive disease are eligible as long as all the lesions assessed for HER2 on both sides are negative
• In both the above cases, the lesion considered at highest risk for recurrence based on the investigator's discretion will be used for eligibility determination
• Documented germline mutation in BRCA1 or breast cancer 2, early onset (BRCA2) that is predicted to be deleterious or suspected deleterious (known or predicted to be detrimental/lead to loss of function); local germline (g)BRCA testing results, if available, will be used for establishing eligibility; if local gBRCA testing results are not available, central testing will be provided for those patients who otherwise appear to be eligible
• Completed adequate breast surgery defined as: * The inked margins of breast conservation surgery or mastectomy must be histologically free of invasive breast cancer and ductal carcinoma in situ with the exception of the posterior margin if this margin is the pectoralis major fascia or the anterior margin if this is the dermis; patients with resection margins positive for lobular carcinoma in situ are eligible * Patients with breast conservation must have adjuvant radiotherapy; patients having mastectomy may have adjuvant radiotherapy according to local policy and/or international guidelines
• Completed adequate axilla surgery defined as: * ADJUVANT CHEMOTHERAPY PATIENTS: ** Sentinel lymph node biopsy alone if negative or if lymph node(s) only contain micrometastases (=< 2.0 mm) OR ** Positive sentinel lymph node biopsy followed by axillary nodal dissection or radiotherapy as per local guidelines OR ** Axillary dissection * NEOADJUVANT CHEMOTHERAPY PATIENTS: ** Sentinel lymph node biopsy performed before neoadjuvant chemotherapy: *** If negative or if lymph node(s) only contain micrometastases (=< 2.0 mm), additional axillary surgery is not required *** If positive, axillary node dissection or axillary nodal radiotherapy should follow completion of neoadjuvant chemotherapy ** Sentinel lymph node biopsy performed after neoadjuvant chemotherapy: *** If negative, additional axillary surgery not mandated *** If positive (micrometastases are regarded as positive), additional axillary surgery is required unless the patient is enrolled in a phase III multicenter clinical trials proposing radiotherapy as alternative treatment of the axilla; the trial must be pre-approved by the OlympiA Executive Committee ** Axillary dissection
• Completed at least 6 cycles of neoadjuvant or adjuvant chemotherapy containing anthracyclines, taxanes or the combination of both; prior platinum as potentially curative treatment for prior cancer (e.g. ovarian) or as adjuvant or neoadjuvant treatment for breast cancer is allowed; (for neoadjuvant patients all chemotherapy should be delivered prior to surgery; no further cycles of chemotherapy post-surgery are allowed)
• Hemoglobin >= 10.0 g/dL (measured within 28 days prior to randomization)
• Absolute neutrophil count (ANC) >= 1.5 x 10^9/L (measured within 28 days prior to randomization)
• Platelet count >= 100 x 10^9/L (measured within 28 days prior to randomization)
• Total bilirubin =< ULN (institutional upper limit of normal) except elevated total bilirubin < 1.5 x ULN due to Gilbert’s disease or similar syndrome involving slow conjugation of bilirubin (measured within 28 days prior to randomization)
• Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x ULN (measured within 28 days prior to randomization)
• Alkaline phosphatase (ALP) =< 2.5 x ULN (measured within 28 days prior to randomization)
• Patients with screening ALT/AST or ALP above institutional upper limit of normal should have liver ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) at any time point between diagnosis of current breast cancer and randomization; screening bone scan is required if ALP and/or corrected calcium level are above the institutional upper limit; (note positron emission tomography [PET]/CT scan may be used as an alternative imaging technique)
• Serum or plasma creatinine =< 1.5 x ULN (measured within 28 days prior to randomization)
• Eastern Cooperative Oncology Group (ECOG) performance status 0-1
• Women who are not postmenopausal or have not undergone a hysterectomy must have documented negative pregnancy test within 28 days prior to randomization * Postmenopausal is defined as one or more of the following: ** Age >= 60 years (yrs) ** Age < 60 and amenorrheic for 1 year or more in the absence of chemotherapy and/or hormonal treatment ** Follicle-stimulating hormone (FSH) and plasma estradiol levels in the post menopausal range for women under 60 ** Radiation-induced oophorectomy with last menses > 1 year ago ** Bilateral oophorectomy * Women of childbearing potential who are sexually active must agree, with their partners, to the use of two highly effective forms of contraception in combination; this should be started from the signing of the informed consent and continue, throughout the period of taking study treatment and for at least 1 month after the last dose of study drug, or they must totally/truly abstain from any form of sexual intercourse; male patients must use a condom during treatment and for 3 months after last dose of study drug when having sexual intercourse with a pregnant woman or with a woman of childbearing potential; female partners of male patients should also use a highly effective form of contraception if they are of childbearing potential
• Patient is willing and able to comply with the protocol for the duration of the study including undergoing treatment and scheduled visits and examinations
• Formalin fixed, paraffin embedded (FFPE) tumor sample from the primary tumor, mandatory * NOTE: for adjuvant patients this refers to the surgical specimen; for neoadjuvant patients, both the pre-treatment core biopsy and the surgical specimen with residual disease are requested but only one is mandatory; if the surgery tumor blocks are available, but cannot be submitted, sites may submit a portion of invasive tumor from the original block, either by taking at least one core of at least 3 mm in diameter, or by splitting the original block in two parts, and re-embedding one in a new block for central submission; if blocks containing pre-neoadjuvant treatment core biopsies are available but cannot be submitted, sections mounted on glass slides prepared from the block can be provided; if tumor sample can't be provided as requested above or if it's not available, approval by study team for patient's entry into the trial is required
• Patient should be randomized in the trial ideally within a maximum of 8 weeks of completion of their last treatment (surgery, chemotherapy or radiotherapy), but in no case longer than 12 weeks

Exclusion Criteria

• Involvement in the planning and/or conduct of the study
• Patients who do not have deleterious or suspected deleterious gBRCA1 and/or 2 mutations but only have BRCA1 and/or BRCA2 mutations that are considered to be non-detrimental (e.g., “variants of uncertain clinical significance” or “variant of unknown significance” or “variant, favor polymorphism” or “benign polymorphism” etc.)
• Previous randomization in the present study
• Evidence of metastatic breast cancer; patient considered at high risk of having disseminated disease (i.e. those with locally advanced disease, clinical N2-3 or pathological N1-3 with the exception of pN1a in adjuvant patients) should have a CT/MRI scan of the thorax/abdomen/pelvis or any other area as clinically indicated and a bone scan or a CT scan with bone windows at any point between diagnosis of the current breast cancer and randomization to rule out metastatic breast cancer; (note PET/CT scan may be used as an alternative imaging technique and precludes the need for bone scan); patients with screening ALT/AST or ALP above institutional upper limit of normal should have liver ultrasound, CT or MRI at any time point between diagnosis of current breast cancer and randomization; screening bone scan is required if ALP and/or corrected calcium level are above the institutional upper limit; (note PET CT scan may be used as an alternative imaging technique)
• Exposure to an investigational product within 30 days or five half-lives (whichever is the longer) prior to randomization
• Any previous treatment with a PARP inhibitor, including olaparib and/or known hypersensitivity to any of the excipients of study treatment
• Patients with second primary malignancy, EXCEPTIONS are: * Adequately treated non-melanoma skin cancer, curatively treated in situ cancer of the cervix, ductal carcinoma in situ (DCIS) of the breast, stage 1 grade 1 endometrial carcinoma * Other solid tumors and lymphomas (without bone marrow involvement) diagnosed >= 5 years prior to randomization and treated with no evidence of disease recurrence and for whom no more than one line of chemotherapy was applied
• Resting electrocardiogram (ECG) with corrected QT (QTc) > 470 msec detected on 2 or more time points within a 24 hour period or family history of long QT syndrome; if ECG demonstrates QTc > 470 msec, patient will be eligible only if repeat ECG demonstrates QTc =< 470 msec
• Patients receiving systemic chemotherapy within 3 weeks prior to randomization
• Patients receiving adjuvant radiotherapy within 2 weeks prior to randomization
• Concomitant use of known strong CYP3A4 inhibitors (e.g., itraconazole, telithromycin, clarithromycin, protease inhibitors boosted with ritonavir or cobicistat, indinavir, saquinavir, nelfinavir, boceprevir, telaprevir) or moderate CYP3A inhibitors (e.g., ciprofloxacin, erythromycin, diltiazem, fluconazole, verapamil); the required washout period prior to starting study treatment is 2 weeks; concomitant use of known strong (e.g., phenobarbital, enzalutamide, phenytoin, rifampicin, rifabutin, rifapentine, carbamazepine, nevirapine and St John's wort) or moderate CYP3A inducers (e.g., bosentan, efavirenz, modafmil); the required washout period prior to starting study treatment is 5 weeks for enzalutamide or phenobarbital and 3 weeks for other agents
• Persistent toxicities (>= Common Terminology Criteria for Adverse Events [CTCAE] grade 2) caused by previous cancer therapy, excluding alopecia and CTCAE grade 2 peripheral neuropathy
• Patients with current or past history of hematologic malignancies and any clonal non-malignant hematological disorder which predisposes the patient to develop a hematological malignancy; exception: lymphoma
• Major surgery within 2 weeks prior to randomization: patients must have recovered from any effects of any major surgery
• Patients considered at poor medical risk due to a serious, uncontrolled medical disorder, non-malignant systemic disease or active, uncontrolled infection; examples include, but are not limited to, uncontrolled ventricular arrhythmia, recent (within 3 months) myocardial infarction, uncontrolled major seizure disorder, extensive bilateral lung disease on high resolution computed tomography scan or any psychiatric disorder that prohibits obtaining informed consent
• Patients unable to swallow orally administered medication and patients with gastrointestinal disorders likely to interfere with absorption of the study medication
• Pregnant or breastfeeding women
• Patients with known active hepatitis B or C
• Patients known to be human immunodeficiency virus (HIV) positive with one or more of the following: * Baseline cluster of differentiation (CD)4 count of < 250 cells/mm^3 * History of acquired immune deficiency syndrome (AIDS) indicator conditions * Anti-retroviral therapy with any potent CYP3A4 inhibitor
• Previous allogeneic bone marrow transplant
• Whole blood transfusions in the last 120 days prior to entry to the study which may interfere with gBRCA testing (packed red blood cells and platelet transfusions are acceptable)