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All 19 patients experienced AEs that were considered to be causally related to paclitaxel, the most common of which were neutropenia, fatigue, alopecia and diarrhea. One patient died in cohort 1 due to disease progression and multiple organ failure. Treatment dose modifications Eight patients in cohort 1 had paclitaxel dose modifications, six of whom had both a delay and a dose reduction. Four patients had olaparib dose modifications due to neutro penia. one of these patients also had a dose interruption of olaparib because of infection and anemia, and another of these four patients had a dose interruption of olaparib due to skin infection and skin disorder.

In cohort 2, six patients had paclitaxel dose modifications, with three having both a delay and Efficacy ORR in cohort 1 was 3/9 patients and in cohort 2 was 4/10 patients. Median PFS was 6. 3 months for cohort 1 and 5. 2 months for cohort 2. These esti mated medians are based on very few events so should be interpreted with caution. Discussion Current treatment options for TNBC are limited and there is no standard of care for patients with mTNBC who have progressed following treatment with standard chemotherapeutic regimens. The use of PARP in hibitors to target DNA repair deficiencies in combin ation with systemic therapies continues to generate considerable clinical interest. Previously, olaparib 400 mg bid monotherapy led to promising clinical outcomes in a proof of principle trial a dose reduction. Three patients had olaparib dose modifications. two patients due to neutropenia with one of these patients also undergoing dose modifi cations of olaparib due to pyrexia, herpes zoster and aphasia. The other patient had dose modifications of olaparib due to increased blood bilirubin, abnormal blood lactate dehydrogenase and abnormal gamma glutamyltransferase. in patients with BRCA deficient breast cancers, despite prior data suggesting that 100 mg bid might be sufficient to inhibit PARP. We chose an olaparib dose of 200 mg bid for use in combination with standard pacli taxel dosing.

In the Phase I run in component of our study, which was performed to ensure safe delivery of olaparib with paclitaxel, the combination had a generally manageable toxicity profile in patients with TNBC. How ever, despite this patient cohort not being heavily pre treated and not having excessive bone marrow involve ment, the treatment combination was associated with a greater than expected incidence and severity of neutro penia, which resulted in delivery of a lower paclitaxel dose intensity than planned. Although the administration of prophylactic G CSF to patients in cohort 2 led to an in crease in paclitaxel dose intensity, the paclitaxel dose was still lower than anticipated and the rate of neutropenia remained high. A suitable dosing schedule could not be iden tified for the Phase II part of our study. therefore, the study was terminated at the end of Phase I.