Which Ovarian Cancer Patients Should Get PARP Inhibitor Maintenance Therapy?

The decision differs based on BRCA and HRD status

• The SOLO-1 and PRIMA trials showed a benefit from PARP maintenance therapy for patients with BRCA- and HRD-positive ovarian cancers
• The decision is less clear in patients who are BRCA- and HRD-negative
• For these patients, decision-making requires a thoughtful discussion about risks versus survival benefits

PARP inhibitors are becoming an increasingly important part of the care for ovarian cancer. Professional medical societies have started to weigh in on how these drugs should be incorporated into clinical care, but providers still have many unanswered questions about their use.

The one question Dr. Stephanie Wethington struggles most with is whether to use PARP inhibitor maintenance therapy for all of her ovarian cancer patients in the upfront setting. For patients with germline or somatic BRCA mutations, data from the SOLO-1 and PRIMA trials point to a clear benefit. “Those patients I’m going to target towards utilization of PARP inhibitors,” says Dr. Wethington, who is director of The Susan L. Burgert M.D. Gynecologic Oncology Survivorship Program and assistant professor in the Department of Gynecology and Obstetrics at Johns Hopkins Medicine.

The question is less clear in patients who are BRCA-, and homologous recombination deficiency (HRD)-negative. Olaparib (brand name: Lynparza) isn’t FDA-approved for this group, so niraparib or a clinical trial are the only options. Decision-making for these patients requires a deeper discussion about the survival benefit from PARP inhibitors based on study data, versus potential quality of life issues such as medication adherence and side effects.

“Different patients are going to feel differently about the PFS benefit that they may or may not get from these regimens,” Dr. Wethington tells SurvivorNet Connect.