Ovarian Cancer

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Should PARP Inhibitors be Given to All Patients?

Dr. Ritu Salani Ohio State University Wexner Medical Center

Ovarian cancer specialists around the country are increasingly excited about the new treatment possibility of PARP inhibitors, and one reason is that more and more research is finding that there is some benefit for many different kinds of patients.

Most recently, the American Society of Clinical Oncology (ASCO) released new guidelines recommending PARP inhibitors be offered to women, with or without genetic mutations, who are newly diagnosed with stage III or IV ovarian cancer and have improved with chemotherapy.

This class of drug has been shown to provide benefit for patients with ovarian cancer as part of an initial plan of treatment. PARP inhibitors are primarily still used in women whose disease has come back, or as part of an ongoing course of treatment called maintenance therapy. In maintenance therapy, women whose ovarian cancer has recurred take PARP inhibitors following 4-6 cycles of platinum-based chemotherapy. The goal: keep the cancer in remission for as long as possible.

One of the key things to know about PARP inhibitors is that your genetic makeup and specific features of your cancer will have a significant impact on how effective these drugs may be. Experts tell SurvivorNet that every women with ovarian cancer should get a genetic test to determine if they have a mutation called BRCA, because the mutation enables PARP inhibitors to function much more powerfully. Importantly, there is increasing data that even women without BRCA mutations can still derive some benefit from these drugs.

Again, it’s really important to know that many doctors are still getting comfortable with PARP inhibitors, and because the research is developing so quickly, your genetic makeup and the stage of your cancer may well make you a potential candidate.

But which patients should take PARP inhibitors for this kind of maintenance?

PARP inhibitors are best used in women as maintenance therapy if they’ve responded well to platinum-based chemotherapy. These types of patients are known as ‘platinum-sensitive’, meaning they responded well to a chemotherapy that uses platinum as its base.

PARP inhibitors are approved for use for women who have had a response to what’s called a platinum-based chemotherapy.

As we said, women with BRCA mutations respond best to PARP inhibitors. But why? Tumor cells with BRCA mutations have problems repairing DNA already, and the PARP inhibitors make that worse, causing cancer cells to die. Nonetheless, women without BRCA mutations at all have still shown more benefit as compared to observation or ‘watchful waiting.’

Ultimately, while PARP inhibitors can be beneficial for many women with ovarian cancer, it doesn’t necessarily mean everyone should take them. There are some significant side effects to consider, and thus, the decision to take PARP inhibitors should be made in consultation with your individual oncologist.

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Dr. Ritu Salani is a gynecologic oncologist and associate professor in the Department of Obstetrics and Gynecology at The Ohio State University Wexner 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.