Over the last few years, we have been more strategically targeting ovarian cancer treatment based on a patient’s BRCA or homologous recombination deficiency (HRD) status. “We’ve seen a complete transformation in how we think about ovarian cancer,” says Dr. Stephanie Wethington, gynecologic oncologist at Johns Hopkins Medicine.
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In the PAOLA trial, ovarian cancer patients received either bevacizumab alone or bevacizumab plus olaparib (brand name: Lynparza) after their frontline therapy. “And what they found in this trial was very interesting,” says Dr. John Nakayama, gynecologic oncologist with Allegheny Health Network in Pittsburgh.
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PARP inhibitors are a class of drugs that inhibit one of the backup systems of DNA damage repair. Ovarian cancers with BRCA1, BRCA2, or certain other mutations have a defect in a major DNA damage repair pathway and are highly dependent on secondary pathways for their survival.
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The typical treatment for patients with advanced ovarian cancer is surgery plus platinum-based chemotherapy. Although most patients go into remission following this regimen, an estimated 70% relapse within the next three years.
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When it comes to PARP inhibitors, Dr. Rebecca Arend of the University of Alabama says, “The message is not that each patient should get a PARP inhibitor no matter what, but that it is an awareness that we need to put out into the community.”
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Prescribing any medication or course of treatment involves weighing the risks versus the benefits to the patient, but balancing this equation is particularly crucial with cancer drugs which carry significant side effects and toxicity. As the data on treating ovarian cancer with PARP inhibitors becomes more promising and their use becomes more widespread, oncologists are looking for information on patient tolerance.
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PARP inhibitors like niraparib (Zejula) are an effective tool against ovarian cancer. The NOVA trial established that niraparib as maintenance therapy in platinum-sensitive patients significantly improved progression-free survival compared to placebo, regardless of women's BRCA or homologous recombination deficiency (HRD) status. Then, the PRIMA study found the treatment extended PFS in patients with newly diagnosed ovarian cancer, with or without HRD deficiency.
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How to determine which ovarian cancer patients will benefit most from PARP inhibitors such as olaparib (brand name: Lynparza) is still a big question in oncology. “If you're going to use a selective strategy to identify patients for PARP inhibitors, there are different approaches, different pathways,” says Dr. Stephanie Wethington, gynecologic oncologist at Johns Hopkins Medicine.
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Treating Recurrence after PARP Therapy Maintenance therapy with PARP inhibitors is still relatively new There are no clear guidelines yet for how to treat women with platinum-sensitive tumors when they recur after PARP maintenance therapy New trials, such as MEDIOLA, suggest a triplet option Four years ago the FDA approved the first PARP inhibitor (niraparib) […]
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