Dr. Gunderson on the Use of PARP Inhibitors in All-Comers With Ovarian Cancer

Camille C. Gunderson, MD, assistant professor of gynecologic oncology, Stephenson Cancer Center, discusses the use of PARP inhibitors in all-comers with ovarian cancer.

In December 2018, olaparib (Lynparza) received regulatory approval as frontline maintenance therapy in patients with advanced ovarian cancer who harbor germline or somatic BRCA mutations. The decision is based on data from the phase III SOLO-1 trial, which showed a significant benefit in progression-free survival and time to first and second subsequent therapy or death with the agent versus placebo. Though data from the phase III PAOLA-1, PRIMA, and VELIA trials all showed a benefit with maintenance PARP inhibition in this setting, none of the other FDA-approved PARP inhibitors have received regulatory approval as frontline maintenance therapy, says Gunderson.

The benefit of PARP inhibition was observed in all-comers in these 3 trials, irrespective of homologous recombination deficiency (HRD) status or BRCA status, begging the question of whether bevacizumab (Avastin) or PARP maintenance should be used in patients with HRD defects or somatic BRCA mutations. The benefit of frontline PARP maintenance is clear in patients with germline BRCA mutations, says Gunderson. However, the benefit in all-comers will make patient selection more challenging, she concludes.