# Overall survival in the OlympiA phase III trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1/2 and high-risk, early breast cancer

Source: https://onco.cc/key-papers/paper-olympia-overall-survival-ann-oncol-2022/  
OnCo record `paper-olympia-overall-survival-ann-oncol-2022` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The second planned analysis of OlympiA, at 3.5 years, in which a year of olaparib tablets after standard treatment cut deaths by 32 percent in women with an inherited BRCA fault, the first time a PARP inhibitor had lengthened life in early breast cancer.

## Summary

Geyer, Garber, Gelber, Yothers and colleagues report the pre-specified second interim analysis of overall survival in OlympiA, which randomised 1,836 patients with germline BRCA1 or BRCA2 pathogenic variants and high-risk HER2-negative early breast cancer to a year of olaparib or placebo after neoadjuvant or adjuvant chemotherapy, surgery and radiotherapy. With a median follow-up of 3.5 years overall survival improved (hazard ratio 0.68, 98.5 percent confidence interval 0.47 to 0.97, p=0.009); four-year overall survival was 89.8 versus 86.4 percent (difference 3.4 percentage points), four-year invasive disease-free survival 82.7 versus 75.4 percent (7.3 points) and distant disease-free survival 86.5 versus 79.1 percent (7.4 points), with benefit across major subgroups and no new safety signals, including no new acute myeloid leukaemia or myelodysplastic syndrome.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: tnbc-evidence
- Journal: Annals of Oncology
- Year: 2022
- DOI: 10.1016/j.annonc.2022.09.159
- Authors: Geyer CE, Garber JE, Gelber RD, et al.
- Findings: Overall survival hazard ratio 0.68 (98.5 percent CI 0.47 to 0.97), p=0.009, at 3.5 years median follow-up.; Four-year overall survival 89.8 vs 86.4 percent; invasive disease-free survival 82.7 vs 75.4 percent; distant disease-free survival 86.5 vs 79.1 percent.; No new cases of acute myeloid leukaemia or myelodysplastic syndrome.
- What it means: The survival result that moved adjuvant olaparib from a disease-free survival approval to an undisputed standard, and the reason germline testing at diagnosis of triple-negative breast cancer is now a treatment decision rather than a family history exercise.
- Caveats: About 82 percent of participants had triple-negative disease; hormone receptor-positive carriers were a minority.; Interim analysis with a stricter alpha; the six-year update is the mature result.

## Sources

- Ann Oncol 2022: https://doi.org/10.1016/j.annonc.2022.09.159
- PubMed: https://pubmed.ncbi.nlm.nih.gov/36228963/
- ClinicalTrials.gov NCT02032823: https://clinicaltrials.gov/study/NCT02032823

## Connected records

- key papers: [OlympiA: a year of olaparib after surgery for BRCA-mutated, high-risk early breast cancer](https://onco.cc/key-papers/paper-olympia-nejm-2021/), [Sustained benefit of adjuvant olaparib in women with germline BRCA1- and BRCA2-associated high-risk HER2-negative early breast cancer: updated results from the OlympiA phase III trial](https://onco.cc/key-papers/paper-olympia-6-year-update-ann-oncol-2026/)
- cancers: [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- technologies: [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [PARP inhibitors](https://onco.cc/technologies/parp-inhibitor/)
- targets: [BRCA1 / BRCA2 (HRD)](https://onco.cc/targets/brca/)
- drugs: [Olaparib](https://onco.cc/drugs/olaparib/)
- companies: [AstraZeneca](https://onco.cc/companies/astrazeneca/), [Merck & Co. (MSD)](https://onco.cc/companies/merck/)
- terms: [Hazard ratio (HR)](https://onco.cc/terms/hazard-ratio/), [Overall survival (OS)](https://onco.cc/terms/os/)
- trials: [OlympiA](https://onco.cc/trials/olympia/)
- people: [Andrew Tutt](https://onco.cc/people/andrew-tutt/), [Charles E. Geyer Jr.](https://onco.cc/people/charles-geyer/), [Judy E. Garber](https://onco.cc/people/judy-garber/)
- journals: [Annals of Oncology](https://onco.cc/journals/annals-of-oncology/)
- roadmaps: [Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem](https://onco.cc/roadmaps/tnbc-roadmap/)

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