What Does a New Ovarian Cancer Drug Combo Approval Mean for Patients?

A two-drug combination recently approved by the U.S. Food and Drug Administration (FDA) might prolong the time before a woman’s ovarian cancer returns, and help some women avoid chemotherapy. And, unlike other approved treatments, it may work for a larger number of women.

The new drug combination consists of olaparib (Lynparza), which is a PARP inhibitor, and bevacizumab (Avastin), which is a targeted therapy. Lynparza was one of the first PARP inhibitors to receive approval from the FDA. This class of drugs work by blocking your body’s natural DNA repair mechanisms, which prevents cancer cells from growing and thriving. Additionally, studies are now suggesting that treatment with PARP inhibitors can significantly extend the length of time until the cancer recurs or worsens.

“We really like olaparib, and we think it works the best on tumors that have problems with the DNA repair mechanism,” says Dr. Derrick Haslem, medical oncologist with Intermountain Healthcare in Logan, Utah, near Salt Lake City. “That is often seen in mutations like BRCA, but we know that olaparib works in all ovarian cancer patients.”

A Treatment for More Women

This means that, unlike some PARP inhibitors, which are only approved for women with BRCA gene mutations, any women with ovarian cancer is potentially eligible for treatment with Lynparza. And thanks to the recent approval, Lynparza is now getting paired up with Avastin.

While PARP inhibitors are available to almost all women, women with BRCA gene mutations or who are HRD proficient may benefit the most from these drugs. However, the American Society of Clinical Oncology (ASCO) released new guidelines recommending PARP inhibitors be offered to women, with or without genetic mutations, who are newly diagnosed with stage III or IV ovarian cancer and have improved with chemotherapy.

Given intravenously (through a vein), Avastin is a targeted therapy that helps block the formation of new blood vessels that feed and nourish the cancer cells. “It’s a very effective drug that’s been around for a while now. We’re very comfortable using it, and it has very minimal side effects,” says Dr. Haslem.

With new therapies and combination treatments now available, in some situations, women with ovarian cancer may not need to take chemotherapy at all. That could help them avoid hair loss, nausea, and other side effects that typically accompany chemotherapy.

Of course, not everyone should avoid chemotherapy, as it may be essential as part of their treatment, “but it just is exciting to me as a doctor to think that we are moving beyond chemotherapy,” says Dr. Haslem. “We’re coming out with new agents that are better tolerated, and we’ll continue to keep people around for much longer, in spite of a diagnosis of ovarian cancer.”

Possible Side Effects

Like most cancer therapies, treatment with this drug combination can result in potential side effects.  However, these side effects are different than what can occur with chemotherapy or other types of treatment.  “Any time you’re introducing new agents into your body, there’s a chance that there might be some issues that arise,” says Dr. Haslem. “We don’t see them very often, but there are some potential side effects.”

The two-drug combination can affect the blood and result in low blood cell counts, which is very similar to what happens when a PARP inhibitor is used alone. “There is a potential for blood clots and bleeding and wound healing complications,” says Dr. Haslem. When Avastin is added, it may heighten these effects.

Additional side effects from Avastin can include:

• High blood pressure
• Numbness or tingling in the hands or feet
• Fatigue and weakness
• Constipation or diarrhea

A rare but potentially serious side effect is bowel perforation–a hole in the wall of the GI tract. This drug can also cause kidney damage, which can sometimes be permanent.

Other common side effects that may result from PARP inhibitor treatment include nausea, vomiting, stomach upset, and fatigue.  Fortunately, nausea and other GI symptoms don’t seem to get worse when Avastin is taken together with Lynparza.

Have a discussion about all of these potential side effects, but know that your doctor will take every precaution when treating you. “These drugs are prescribed by skilled professionals who are going to know exactly what to watch for,” says Dr. Haslem.

Good communication is also key once you start on these medications. Report any side effects to your doctor during your regular visits. Your doctor may be able to adjust the medication dose, or recommend other methods to help alleviate them.

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