Managing Side Effects: Which PARP Inhibitor Is Right For Me?

Dr. Dorigo says the decision will come down to a discussion with your physician, who will make a recommendation for a PARP inhibitor based on your personal circumstances and past experiences. For example, a patient with a previous history of significant damage to their bone marrow or who experienced heavy blood loss or anemia should shy away from certain PARP inhibitors known for altering blood counts.

Side Effects

Side effects for PARP inhibitors include anemia, gastrointestinal discomfort like nausea and vomiting, and fatigue. Each PARP inhibitor may have varying intensities of these side effects for different patients, but the medical community hasn’t gathered enough data to be able to create strict guidelines on PARP inhibitors. Dr. Dorigo says, “I think we are about to generate better guidelines, better criteria, to select the most appropriate PARP inhibitor for each patient. This is data that we will see in the next few years.” However, Dr. Dorigo also emphasizes that you should bring any knowledge you have of the other drugs to your provider and create an open discussion to decide which of the three is best. “I am personally open to a discussion about all three different choices,” states Dr. Dorigo.

Learn more about the side effects of PARP inhibitors here.

Summary of PARP Eligibility

PARP inhibitors are options for women as maintenance therapy after first chemotherapy or platinum sensitive recurrence, or as treatment for recurrence. The benefit a woman may see from this class of medication varies greatly, with the biggest determinant being the presence of an inherited or tumor mutation in BRCA.

Newly-Diagnosed Epithelial ovarian cancer

1. The PARP inhibitor Zejula (niraparib) has been approved by the FDA for all women with newly-diagnosed ovarian cancer regardless of BRCA or HRD status. 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

Unfortunately, too often, ovarian cancer comes back.

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.

Again, it is important to point out that the different PARP inhibitors do have varying side effects, which oncologists need to evaluate carefully.

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