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Article History

Received: 23 January 2026

Accepted: 20 June 2026

First Online: 11 July 2026

Competing interests

: C.G.-D. reports advisory roles from EISAI, MSD, and GlaxoSmithKline; and participation in Speakers’ Bureau for GlaxoSmithKline and AstraZeneca. M.R. reports honoraria for talks from Myriad Genetics. M.O. reports advisory and consulting roles from AstraZeneca, Cureos Science, Daiichi Sankyo/AstraZeneca, Gilead, iTEOS, Lilly, MSD, Relay Therapeutics, Roche, and Seagen; has received honoraria from AstraZeneca, Eisai, Gilead, Libbs, Lilly, MSD, Novartis, Pfizer, Roche, and Seagen; received travel grants from AstraZeneca, Eisai, Gilead, Pierre Fabre; and currently serves as the President of the SOLTI Breast Cancer Group. C.S. reports consulting fees, honoraria, or meeting/travel support from AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Eisai, Genentech, Gilead, Lilly, MediTech, Menarini, MSD Spain, Novartis, Pfizer, Philips Healthcare, Pharmalex, Pierre Fabre, Puma Biotechnology, Roche, Seagen, Synthon, and Zymeworks; is a member of the SOLTI Executive Board and Scientific Committee; reports nonfinancial support from the Cellex Foundation, the CERCA Programme from the Generalitat de Catalunya, and the State Agency for Research; and has received grants from Paseico de la Mama, the FERO-GHD Foundation, the Spanish Association Against Cancer Foundation (FAECC; Junior Clinical Award), SEOM–Daiichi Sankyo, the Department of Health–Generalitat de Catalunya, and Instituto de Salud Carlos III (ISCIII) and Fondo Europeo de Desarrollo Regional (FEDER; cofounded by the European Union) during the conduct of the study. C.D. reports grants from the European Commission H2020, German Cancer Aid Translational Oncology, and the German Breast Group (outside of the study); institutional support from Myriad for HRD implementation; personal fees from BionTech, Roche, MSD Oncology, Daiichi Sankyo, AstraZeneca, and Sividon Diagnostics (outside the submitted work); a patent for VMScope digital pathology software with royalties paid; patent WO2020109570A1 (cancer immunotherapy) pending; and patents WO2015114146A1 and WO2010076322A1 (therapy response) issued. C.J.L. makes the following disclosures: receives and/or has received research funding from: AstraZeneca, Merck KGaA, Artios, Neophore, FoRx. Received consultancy, SAB membership, or honoraria payments from: FoRx, Syncona, Sun Pharma, Gerson Lehrman Group, Merck KGaA, Vertex, AstraZeneca, Tango Therapeutics, 3rd Rock, Ono Pharma, Artios, Abingworth, Tesselate, Dark Blue Therapeutics, Pontifax, Astex, Neophore, Glaxo Smith Kline, Dawn Bioventures, Blacksmith Medicines, ForEx, Ariceum. Has stock in: Tango, Ovibio, Hysplex, Tesselate, Ariceum. C.J.L. is also a named inventor on patents describing the use of DNA repair inhibitors and stands to gain from their development and use as part of the ICR “Rewards to Inventors” scheme and also reports benefits from this scheme associated with patents for PARP inhibitors paid into C.J.L.’s personal account and research accounts at the Institute of Cancer Research. A.N.J.T. reports personal honoraria from AstraZeneca, ForEx Therapeutics, Nauge Therapeutics, honoraria to either The Institute of Cancer Research or King’s College research accounts for advisory boards from AstraZeneca, Page Therapeutics, Ellipses, Tango Therapeutics, Guardant Health, Merck KGaA, and stock and financial support for research from AstraZeneca and Inbiomotion, Myriad Genetics, Merck KGaA. Travel expenses covered by AstraZeneca. A.T. reports benefits from ICR’s Inventors Scheme associated with patents for PARP inhibitors in BRCA1/2 associated cancers, paid into research accounts at The Institute of Cancer Research and to A.T.’s personal account. A.P. reports advisory and consulting fees from AstraZeneca, Roche, Pfizer, Novartis, Daiichi Sankyo, and Peptomyc; lecture fees from AstraZeneca, Roche, Novartis, and Daiichi Sankyo; institutional financial interests from AstraZeneca, Novartis, Roche, and Daiichi Sankyo; is a stockholder and employee of Reveal Genomics; and has filed patents PCT/EP2016/080056, PCT/EP2022/086493, PCT/EP2023/060810, EP23382703, and EP23383369. R.D. declares advisory roles for Roche, Foundation Medicine, AstraZeneca, and Pfizer; has received speaker’s fees from Roche, Foundation Medicine, Guardant Health, Ipsen, Amgen, Servier, Sanofi, Libbs, Merck Sharp & Dohme, Lilly, AstraZeneca, Johnson & Johnson, Takeda, Bristol Myers Squibb, GlaxoSmithKline, Gilead, and Pfizer; has received research grants from Merck, Novartis, Daiichi Sankyo, GlaxoSmithKline, Pfizer, and AstraZeneca; and is an investor in Trialing Health SL. A.O. reports consulting fees and participation on a Data Safety Monitoring Board or Advisory Board for AbbVie Inc., Agenus, AstraZeneca, Clovis Oncology, Corcept Therapeutics, Deciphera Pharmaceuticals, Daiichi Sankyo, Debiopharm International, Eisai, Exelixis, F. Hoffmann-La Roche, Genmab, GlaxoSmithKline, ImmunoGen, Itheos, MSD, Mersana Therapeutics, Myriad Genetics, Novocure, OncoXerna Therapeutics Inc., PharmaMar, Regeneron, Sattucklabs, Seagen/Pfizer, Sutro Biopharma, TORL Therapeutics, Zentalis, and Zymeworks; has received honoraria or speakers’ bureau fees from NSGO, Peerview, Peervoice, Medscape, Asociación Colombiana de Ginecólogos Oncólogos, ESO, AstraZeneca, and GlaxoSmithKline; has received travel or other expenses from AstraZeneca, PharmaMar, and Roche; holds leadership roles in the Gynecologic Cancer Intergroup and the European Society for Medical Oncology (ESMO); and is a member of the Gynecologic Cancer Intergroup, ESMO, American Society of Clinical Oncology, Spanish Society of Medical Oncology, and GOG Foundation. J.M. has served as an advisor for AstraZeneca, Amunix/Sanofi, Daiichi Sankyo, Janssen, MSD, Pfizer, and Roche; is a member of the scientific board for Nuage Therapeutics; and has been involved as an investigator in several pharma-sponsored clinical trials, none of them related to this work. J.B. reports personal fees and/or nonfinancial support from AstraZeneca and Pfizer. V.S. reports research grants from AstraZeneca and personal fees from AstraZeneca and GSK. J.B., A.L.-G., and V.S. are co-inventors of a patent related to this work (WO2019122411A1), and A.L.-G. and V.S. are current employees of AstraZeneca. The remaining authors declare no competing interests.