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Vedolizumab ICI Colitis — SCE Medical Oncology MCQ

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HardImmunotherapy & Targeted TherapyVedolizumab ICI ColitisSCE Medical Oncology

A 43-year-old with a germline BRCA1 pathogenic variant has ER-positive, HER2-negative high-risk early breast cancer. After neoadjuvant anthracycline-taxane chemotherapy, surgery and radiotherapy, substantial residual invasive disease remains and the CPS+EG score is 4. What additional systemic treatment should be discussed?

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Correct answer: B — Give one year of olaparib alongside indicated adjuvant endocrine therapy

This ER-positive, HER2-negative tumour with a germline BRCA1 variant, residual disease and CPS+EG score 4 meets the high-risk post-neoadjuvant criterion for one year of adjuvant olaparib. Because it is hormone-receptor positive, indicated endocrine therapy is continued alongside olaparib. Give one year of olaparib in place of adjuvant endocrine therapy: olaparib does not replace endocrine treatment in hormone-receptor-positive disease. Give six months of olaparib alongside indicated adjuvant endocrine therapy: the evidence-based duration is one year. Give one year of talazoparib alongside indicated adjuvant endocrine therapy: OlympiA tested olaparib rather than talazoparib. Give one year of olaparib concurrently with postoperative platinum chemotherapy: concurrent postoperative platinum is not the OlympiA regimen. If this were triple-negative breast cancer, endocrine therapy would not be indicated, although eligible high-risk germline-BRCA disease could still receive one year of olaparib under its separate pathological eligibility criteria.

Reference: NICE NG101 early and locally advanced breast cancer: recommendations (Updated April 2025; link maintenance March 2026): https://www.nice.org.uk/guidance/ng101/chapter/Recommendations; Lynparza UK summary of product characteristics (Current UK SmPC, accessed July 2026): https://www.medicines.org.uk/emc/product/9488/smpc