For women facing ovarian cancer, there are now more options for treatment. A relatively new class of drugs called PARP inhibitors has shown promise in treating patients with specific types of ovarian cancer. Recent research shows that the group of patients able to benefit from these drugs is larger.
"The use of PARP inhibitors has really kind of exploded in ovarian cancer and it’s very exciting," Dr. Ritu Salani, a gynecologic oncologist at Ohio State University Wexner Medical Center, told SurvivorNet in a previous conversation about who can benefit from PARP inhibitors. "There are several different PARP inhibitors that are available in the market and all of them have actually shown that there’s been enhanced benefit or survival outcomes in patients who have BRCA mutations."
How PARP Inhibitors Work
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The PARP inhibitor Zejula (niraparib) has been approved by the FDA for all women with newly-diagnosed ovarian cancer irrespective of whether the tumor is HRD. The drug is used after successful treatment with a platinum-based chemotherapy, the mainstay chemotherapy for ovarian cancer.
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.
The PARP inhibitor Lynparza (olaparib) is approved for women newly diagnosed with ovarian cancer and with a germline or somatic mutation in BRCA1/2.
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.
The different PARP inhibitors do have some varying side effects, which oncologists need to evaluate carefully. Some of these considerations are explained here.
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