Dr Chambers on FDA-Approved PARP Inhibitors in the Ovarian Cancer Treatment Arena

Laura J. Chambers, DO, assistant professor, Division of Gynecologic Oncology, The Ohio State University, The Ohio State Comprehensive Cancer Center—James ancer Hospital and Solove Research Institute, discusses FDA-approved PARP inhibitors that are considered for use for patients with ovarian cancer.

In the United States, there are currently 3 FDA-approved PARP inhibitors for patients with ovarian cancer, Chambers begins. Over the past few years, although indications in the frontline maintenance setting have remained relatively unchanged, there have been notable updates in the recurrent setting due to more recent data indicating potential survival concerns in certain patient populations, she explains, adding that this shift has influenced how oncologists approach the use of PARP inhibitors.

For patients in the frontline setting who have undergone chemotherapy and surgery with either a partial or complete response, 2 PARP inhibitors are commonly used: olaparib (Lynparza) and niraparib (Zejula), Chambers continues. Olaparib can be administered alone or in combination with bevacizumab (Avastin), particularly for patients with mutations, according to Chambers. The approach to selecting between these 2 treatment options often involves genetic testing, both germline and somatic, to guide treatment decisions, she adds. Additionally, consideration is given to the use of bevacizumab in practice, especially for patients with stage IV disease and suboptimal surgery, where there is evidence supporting its benefit in combination with chemotherapy as a maintenance option, Chambers elucidates.

In clinical practice, the choice of PARP inhibitor is informed by genetic testing results, she expands. Patients who are homologous recombination deficient (HRD)-positive on somatic testing and are planned for bevacizumab maintenance may benefit from the addition of olaparib to their regimen, Chambers says. Conversely, patients not receiving bevacizumab are treated based on germline or somatic testing results, with niraparib considered for those identified as HRD-positive, Chambers notes. For patients with BRCA mutations, olaparib is often preferred, highlighting the personalized approach to treatment selection based on genetic and clinical factors, Chambers concludes.