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Breaking Down the PAOLA Trial — Who Benefits from Olaparib (Lynparza)?

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March 2, 2021

HRD and BRCA Effect on Progression-Free Survival

  • Patients were given either bevacizumab or bevacizumab plus olaparib (brand name: Lynparza) after their frontline platinum therapy
  • There was no significant difference in progression-free survival for HRD-proficient patients
  • Progression free survival increased from 16.6 months to 28.1 months with olaparib for HRD-positive, BRCA negative patients
  • Progression free survival increased from 17.7 months to 37.2 months with olaparib for patients who are both BRCA-positive and HRD-negative
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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. “They found that in the HRD-proficient group—the people who did not have an HRD score that showed an abnormality–there was no difference in progression-free survival between the two groups.” The data showed a difference in survival of 16.9 months versus 16, “which is not statistically significant,” says Dr. Nakayama.

Another group of patients who were BRCA wild type with an HRD positive showed a greater benefit. Their progression free survival was 28.1 versus 16.6 months. “A very large difference, which is consistent with what we’ve seen in other trials such as PRIMA,” says Dr. Nakayama.

The most dramatic benefit, as expected, occurred in the group that was BRCA positive. “The progression-free survival was 37.2 versus 17.7 months,” says Dr. Nakayama. “So you can clearly see the HRD-proficient group doesn’t get a lot of benefits, but the people with HRD deficiencies or BRCA mutations really see a big benefit.”