The New Combination Treatment
- A new two-drug-treatment combination was recently approved by the FDA as maintenance therapy for ovarian cancer
- Maintenance therapy is intended to prolong cancer remission
- The two drugs, olaparib (brand name LYNPARZA) and bevacizumab (brand name Avastin), each fight cancer in different ways
- Oncologists say that for some women, this combination may not necessarily be more effective than a PARP inhibitor alone
In May 2020 the Food and Drug Administration (FDA) approved a new combination of drugs as maintenance therapy for ovarian cancer. The two drugs are olaparib and bevacizumab. Olaparib (brand name Lynparza) is a PARP inhibitor that works by preventing cancer cells from repairing their damaged DNA, causing them to die. Bevacizumab (brand name Avastin) is an anti-angiogenic drug that prevents the formation of new blood vessels, essentially starving cancer cells of nutrients.
Study Finds Significant Benefit
The FDA based their approval on a study done in Europe known as PAOLA-1, which looked at patients who received chemotherapy with bevacizumab, then continued the bevacizumab along with either a placebo or with olaparib. “The study put both together to try to see if there was a benefit”—a difference in progression-free survival between the two groups—says Dr. Lynn Parker, gynecologic oncologist at Norton Cancer Institute in Louisville Kentucky.
Findings suggest that for women with specific gene mutations or biomarkers there was a significant benefit with the combination therapy. “That was true in the population with BRCA mutations, whether it was an inherited mutation (called a germline mutation) or a mutation in the tumor (called a somatic mutation),” experts tell SurvivorNet.
“Looking at the data from that study it seems the group that most likely benefits the most from it are patients with homologous recombination deficiency,” says Dr. Parker. Homologous recombination deficiency, or HRD, is a genetic factor that indicates ovarian cancer cells cannot easily repair their own damaged genetic material.
Another important statistic from the clinical trial is called the hazard ratio, which quantifies the reduction in the risk of the disease recurring. In the PAOLA-1 trial, the hazard ratio in the population of women with either a BRCA mutation or HRD was about 0.3 or 0.4. Meaning they had a 60 to 70 percent reduced risk of the cancer returning when using this maintenance strategy. That’s exciting news for patients and their providers.
More Promising Options for Ovarian Cancer Patients
The approval of this new combination therapy comes on the heels of another recent approval in April 2020 for the PARP inhibitor, niraparib (brand name ZEJULA) as maintenance treatment for ovarian cancer. Initially, women with a BRCA-1 or BRCA-2 genetic mutation had been shown to respond especially well to PARP inhibitors after recurrence, but newer research indicated that almost all women can consider using this PARP inhibitor throughout their treatment. So patients now have options for maintenance therapy using niraparib or using olaparib plus bevacizumab.
Along with these developments, there are more in the pipeline, including immunotherapy treatments. There are also several frontline clinical trials looking at different combinations with immunotherapy. Doctors anticipate that over the next few years ovarian cancer treatments will continue to evolve, and reveal even more opportunities and treatments for patients.
Weighing Treatment Benefits and Risks
PARP inhibitors, while a promising treatment, also carry risks. Dr. Amanika Kumar of the Mayo Clinic spoke to SurvivorNet and cautioned that women need to speak with their doctor to evaluate the benefit of taking a PARP inhibitor to prolong life because the drugs do have toxicities. Patients with HRD (homologous recombination deficiency) have a far better response than those without, and those with BRCA mutations even more so, Dr. Kumar says. Patients who have no mutation or HRD should think carefully about going on these meds.
Dr. Parker agrees. “I think if a patient is in a situation of choosing maintenance, then we need to have those discussions about the risk and the benefits of one option versus both drugs together. Just because something can be given, we [still] have to make sure that it’s as safe as possible, and that patients understand the risks and benefits.”
Learn more about SurvivorNet's rigorous medical review process.
Lynn P. Parker, MD, is a gynecologic oncologist at Norton Cancer Institute in Louisville, KY. Read More
The New Combination Treatment
- A new two-drug-treatment combination was recently approved by the FDA as maintenance therapy for ovarian cancer
- Maintenance therapy is intended to prolong cancer remission
- The two drugs, olaparib (brand name LYNPARZA) and bevacizumab (brand name Avastin), each fight cancer in different ways
- Oncologists say that for some women, this combination may not necessarily be more effective than a PARP inhibitor alone
In May 2020 the Food and Drug Administration (FDA) approved a new combination of drugs as maintenance therapy for ovarian cancer. The two drugs are olaparib and bevacizumab. Olaparib (brand name Lynparza) is a
PARP inhibitor that works by preventing cancer cells from repairing their damaged DNA, causing them to die. Bevacizumab (brand name Avastin) is an anti-angiogenic drug that prevents the formation of new blood vessels, essentially starving cancer cells of nutrients.
Study Finds Significant Benefit
Read More
The FDA based their approval on a study done in Europe known as PAOLA-1, which looked at patients who received chemotherapy with bevacizumab, then continued the bevacizumab along with either a placebo or with olaparib. “The study put both together to try to see if there was a benefit”—a difference in progression-free survival between the two groups—says
Dr. Lynn Parker, gynecologic oncologist at Norton Cancer Institute in Louisville Kentucky.
Findings suggest that for women with specific gene mutations or biomarkers there was a significant benefit with the combination therapy. “That was true in the population with BRCA mutations, whether it was an inherited mutation (called a germline mutation) or a mutation in the tumor (called a somatic mutation),” experts tell SurvivorNet.
“Looking at the data from that study it seems the group that most likely benefits the most from it are patients with homologous recombination deficiency,” says Dr. Parker. Homologous recombination deficiency, or HRD, is a genetic factor that indicates ovarian cancer cells cannot easily repair their own damaged genetic material.
Another important statistic from the clinical trial is called the hazard ratio, which quantifies the reduction in the risk of the disease recurring. In the PAOLA-1 trial, the hazard ratio in the population of women with either a BRCA mutation or HRD was about 0.3 or 0.4. Meaning they had a 60 to 70 percent reduced risk of the cancer returning when using this maintenance strategy. That’s exciting news for patients and their providers.
More Promising Options for Ovarian Cancer Patients
The approval of this new combination therapy comes on the heels of another recent approval in April 2020 for the PARP inhibitor, niraparib (brand name ZEJULA) as maintenance treatment for ovarian cancer. Initially, women with a BRCA-1 or BRCA-2 genetic mutation had been shown to respond especially well to PARP inhibitors after recurrence, but newer research indicated that almost all women can consider using this PARP inhibitor throughout their treatment. So patients now have options for maintenance therapy using niraparib or using olaparib plus bevacizumab.
Along with these developments, there are more in the pipeline, including immunotherapy treatments. There are also several frontline clinical trials looking at different combinations with immunotherapy. Doctors anticipate that over the next few years ovarian cancer treatments will continue to evolve, and reveal even more opportunities and treatments for patients.
Weighing Treatment Benefits and Risks
PARP inhibitors, while a promising treatment, also carry risks. Dr. Amanika Kumar of the Mayo Clinic spoke to SurvivorNet and cautioned that women need to speak with their doctor to evaluate the benefit of taking a PARP inhibitor to prolong life because the drugs do have toxicities. Patients with HRD (homologous recombination deficiency) have a far better response than those without, and those with BRCA mutations even more so, Dr. Kumar says. Patients who have no mutation or HRD should think carefully about going on these meds.
Dr. Parker agrees. “I think if a patient is in a situation of choosing maintenance, then we need to have those discussions about the risk and the benefits of one option versus both drugs together. Just because something can be given, we [still] have to make sure that it’s as safe as possible, and that patients understand the risks and benefits.”
Learn more about SurvivorNet's rigorous medical review process.
Lynn P. Parker, MD, is a gynecologic oncologist at Norton Cancer Institute in Louisville, KY. Read More
