Differences Between Types of PARP Inhibitors
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/ Updated March 9th, 2022

Differences Between Types of PARP Inhibitors

Medically Reviewed: Dr. Monica Vetter Written by: Dr. Oliver Dorigo
Stanford University Medical Center
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Understanding the Different Types of PARP Inhibitors

  • There are three types of PARP inhibitors approved to treat ovarian cancer — olaparib (Lynparza), rucaparib (Rubraca), and niraparib (Zejula).
  • The drugs are largely similar in how they work with slight differences in their side effects for different stages of ovarian cancer.
  • Noted ovarian cancer researchers say the choice of which PARP inhibitor is often dependent on how comfortable the provider is with the individual agent, how the experience of the provider is with the specific drug, and then finally on what the efficacy is from clinical trials and the individual physicians.
  • Women and their families should ask questions and, if desired, play an active role in this decision making process.
For women with ovarian cancer looking at options for PARP inhibitors, which are drugs that kill off cancer cells, there are a three main types: olaparib (brand name Lynparza), rucaparib (brand name Rubraca), and niraparib (brand name Zejula). A leading specialist tells SurivorNet that they are largely similar in how they work, with slight differences in their side effects for different stages of ovarian cancer. These differences will help determine which PARP inhibitor is best for you.

According to Dr. Oliver Dorigo, a gynecologic oncologist at Stanford Medical School, all three drugs block an enzymeknown as PARPused by cells to repair damage to their DNA. Without normally-functioning PARP, some tumor cells may accumulate more and more DNA damage, and eventually die.

What are the Side Effects?

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Dr. Dorigo is quick to point out that each variety of PARP inhibitor differs slightly in its side effects. “The efficacy of these drugs is likewise comparable…Where the PARP inhibitors differ is potentially in their side effect profile,” he says.

Thus, which PARP inhibitor your doctor recommends will take into account the various side effects of these drugs, which include:

  • Nausea–PARP inhibitors can cause nausea and vomiting.
  • Fatigue–As is the case with many cancer treatments, PARP inhibitors can cause tiredness and fatigue.
  • Anemia–At times, PARP inhibitors can effect your bone marrow cells’ ability to repair DNA, which can kill your healthy bone marrow cells. Bone marrow cells are responsible for producing blood cells throughout your body. If the PARP inhibitor causes the patient to have low red blood cells (anemia), a blood transfusion may be needed.

Deciding Which PARP Inhibitor to Take

So, how do you make the decision of which of the three drugs to take? Dr. Dorigo says that the choice ultimately comes down to a discussion with your personal doctor.

  1. The PARP inhibitor Zejula (niraparib) has been approved by the FDA for all women with newly-diagnosed ovarian cancer regardless of whether the tumor is HRD. The drug is used after successful treatment with a platinum-based chemotherapy, the mainstay chemotherapy for ovarian cancer.
  2. Due to limited benefit in progression free survival seen in the absence of HRD, gynecologic oncologists differ on whether PARP inhibitors should be universally recommended in the "upfront maintenance setting." Each patient should be made aware of risks and benefits to PARP inhibitor maintenance and decide with their oncologist what is the best treatment plan for them.
  3. The PARP inhibitor Lynparza (olaparib) is approved for women newly diagnosed with ovarian cancer and with a germline or somatic mutation in BRCA1/2.
  4. Lynparza is also approved in combination with Avastin (bevacizumab) for women with HRD.  Avastin is a blood vessel growth inhibitor, which works by starving the tumor of vital nutrients needed to grow.

Using PARPs To Treat Recurrence

For women with ovarian cancer who have had a recurrence and responded to platinum-based chemotherapy, Lynparza, Zejula and another PARP inhibitor called Rubraca (rucaparib) are FDA approved for use as a maintenance therapy, regardless of whether a woman has a BRCA mutation or HRD.

For some women who have had prior chemotherapy treatments, Rubraca, Zejula or Lynparza may also be options. These uses are based on factors such as number of prior therapies and BRCA mutation or HRD.

Making Treatment Choices

Dr. Dorigo also notes that there isn’t a clear agreement amongst oncologists about which of three drugs is the best choice in certain situations, so they may recommend one drug over another based on their own personal preferences.

The factors that will determine which PARP inhibitor is best in your specific case are:

  • Provider’s comfort with the drug–Some oncologists are more comfortable using one PARP inhibitor versus another. Maybe they’ve been using one drug for years, so they have the best understanding of that specific drug.
  • Provider’s experience with the drug–Perhaps your doctor has seen which drug has been most effective with the least side effects for patients in your specific circumstances before. Your doctor’s experience will be a valuable resource in making the decision.

Learn more about the side effects of PARP inhibitors here.

Learn more about SurvivorNet's rigorous medical review process.

Dr. Oliver Dorigo is a gynecologic oncologist at Stanford University Medical Center. Read More

PARP Inhibitors For Maintenance

PARP inhibitors are an important therapy that traditionally were used after a recurrence of ovarian cancer. Now however, they are also being used for maintenance therapy after initial treatment.

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