Dr. Domchek Discusses Unanswered Questions from the MEDIOLA Trial

Susan Domchek, MD, director of the Basser Center for BRCA at Penn Medicine, discusses some questions that remain after the recent phase II MEDIOLA trial.

The trial, which was presented at the 2017 San Antonio Breast Cancer Symposium, showed that the combination of olaparib (Lynparza), a PARP inhibitor, and durvalumab (Imfinzi), an immunotherapy agent, could be a promising option for patients with BRCA1- or BRCA2-mutant metastatic breast cancer who did not have a response on prior therapies. In the study, 25 women were given the combination. At 12 weeks, there was an 80% clinical benefit rate. Domchek finds these results very promising, especially since there were no additional toxicities other than what would normally be expected for both of the agents.

However, there are still unanswered questions regarding this line of therapy, Domchek says. First, olaparib is effective as a single-agent for this patient population, so it is unclear if durvalumab is enhancing efficacy by providing a prolonged response. Also, more pre-treatment predictors must be identified so that oncologists can better understand who which patients will have the best response with the combination.