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PARP Inhibitors Can Be Effective as Part of Initial Treatment for Ovarian Cancer

Dr. Ursula Matulonis Dana-Farber Cancer Institute

PARP inhibitors are some of the newest additions to ovarian cancer treatment and are receiving lots of attention from oncologists. The inhibitors operate by blocking the ability of cancer cells to repair damaged DNA, eventually leading to the death of these cells and helping patients toward remission. While PARP inhibitors have traditionally been used as a late-stage treatment after cancer has come back, new evidence from a clinical trial suggests that they may be an effective initial treatment in women with a BRCA mutation, according to Dr. Ursula Matulonis, chief of Gynecologic Oncology at the Dana Farber Cancer Institute. SurvivorNet sat down with Dr. Matulonis to talk about the trial and its compelling data about PARP inhibitors.

Dr. Matulonis reveals that all three of the PARP inhibitors that are currently approved by the Food and Drug Administration (FDA) — Olaparib (Lynparza), Niraparib (Zejula), and Rucaparib (Rubraca) — have a “maintenance indication.” This designation means that women who have gone into remission after receiving a platinum-based chemotherapy (a specific kind of chemotherapy used to fight ovarian cancer) can be given PARP inhibitors to maintain their low levels of cancerous cells. For this indication, PARP inhibitors are given late in treatment after the cancer has recurred, and always after multiple rounds of chemotherapy.

New evidence from a recent clinical trial called a “SOLO1” has demonstrated that PARP inhibitors can be beneficial in earlier stages of ovarian cancer treatment, specifically for patients with BRCA mutations. This groundbreaking new evidence supports the use of the PARP inhibitor Olaparib, as an initial ‘upfront’ treatment in newly diagnosed, advanced-stage ovarian cancer following just the first round of chemotherapy. In December 2018, the FDA approved Olaparib for this purpose.

Olaparib can now be used as an upfront treatment in women with newly diagnosed ovarian cancer who:

  • Have BRCA mutations
  • Have mutations in their pathway for a special kind of DNA repair (homologous recombination)
  • Have undergone surgery and one round of chemotherapy

Dr. Matulonis is excited by the new research into improved treatments for ovarian cancer. “These approvals are based upon trials. And there are just a lot of trials upcoming that might expand the indication for those other PARP inhibitors,” she says. For now, however, Olaparib is the only PARP inhibitor approved as an upfront treatment, since it was the medication studied in the trial.

Learn more about the side effects of PARP inhibitors here.

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Dr. Ursula Matulonis is the Chief of the Division of Gynecologic Oncology at Susan F. Smith Center for Women's Cancers at the Dana-Farber Cancer Institute. Read More

Ovarian Cancer Initial Treatment

Deciding the first course of care for ovarian cancer is a crucial conversation between a woman and her gynecologic oncologist. Following a detailed diagnosis of the type of ovarian cancer, doctors typically recommend an aggressive combination of surgery and chemotherapy. Which treatment comes first depends on the stage and grade of the cancer.