What is Niraparib (Zejula)?
- Niraparib (Zejula) is the most recently approved PARP inhibitor — a type of drug that prevents cancer cells from repairing their damaged DNA. (It comes as a pill.)
- Zejula can keep cancer in remission for long periods of time
- Side effects may include nausea, upset stomach, fatigue, and low blood cell counts
- It’s available to almost all ovarian cancer patients, though it may be more effective in those with BRCA gene mutations
In recent years, a group of medications called PARP inhibitors have made great progress in treating ovarian cancer. These drugs work by blocking the body’s natural DNA repair mechanisms in order to stop cancer cells from dividing and replicating. One PARP inhibitor called niraparib (Zejula) is showing particularly promising results.
Most cancer treatments prevent fast-growing cells like cancer cells from dividing and multiplying. PARP inhibitors work in a different way. They block the pathway that allows cancer cells to repair their own damaged DNA. By preventing these cells from fixing their broken DNA strands, PARP inhibitors prevent the cancer cells from continuing to multiply.
Recently approved by the FDA, Zejula has proven to be so effective that it can be used in place of chemotherapy, or as a maintenance strategy to keep ovarian cancer in remission for long periods of time. This is particularly exciting for oncologists like Dr. Haslem, who have seen dramatic improvements in their patients’ overall survival, including their disease-free survival (how long after treatment before their cancer starts to grow).
“The cancer stays in remission for longer, people do better for longer, and they’re just taking pills,” he says.
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.
Side Effects of Zejula
Like any cancer medication, Zejula does come with potential side effects, though they are different from the hair loss and other side effects chemotherapy causes. People who take Zejula may experience:
- Upset stomach
Your oncologist has ways to manage these side effects, and will also monitor your blood cell counts to make sure that your white blood cells, red blood cells, and platelets don’t get too low. Low blood cell counts could lead to infections (white blood cells), anemia (red blood cells), or bleeding (platelets), although the chances of these problems developing are still lower than they are with chemotherapy.
PARP inhibitors can also cause problems with the digestive system. Some patients may experience mild nausea or diarrhea.
“Fatigue is always an issue with any of these cancer drugs,” says Dr. Haslem. However, he notes that patients who maintain as much of their regular lifestyle as possible tend to do better. “An active lifestyle, a well-balanced diet, and exercise remain important,” he says.
Who Can Take Zejula?
Just about all ovarian cancer patients are eligible to use Zejula, though it is more effective for some patients than for others. “Studies have shown that all ovarian cancer patients seem to respond to these drugs,” says Dr. Haslem.
However, he notes, “we are particularly excited about these drugs when people have BRCA mutations or other types of mutations like BRCA, because they seem to work even better.”
BRCA1 and BRCA2 are a set of genes known to be associated with ovarian cancer. Patients with mutations in these genes have a defect in their DNA repair pathways that make their cancers more susceptible to the effects of PARP inhibitors. In the past, PARP inhibitors have only been available to people with this mutation or with very aggressive disease.
With new medications like Zejula, however, that is changing. Though PARP inhibitors continue to work best for women with BRCA mutations, they are now available to more patients than ever before. If you’re interested in trying one of these medications, ask your doctor whether you might be a good candidate.