Dr Huang on the Use of Neoadjuvant PARP Inhibitors in Advanced Ovarian Cancer

Marilyn Huang, MD, MS, Richard and Louise Crockett Endowed Professor, as well as professor and director in the Division of Gynecologic Oncology in the Department of Obstetrics and Gynecology at the University of Virginia Comprehensive Cancer Center, discusses the need for non-chemotherapy options in advanced ovarian cancer, as well as data on the use of neoadjuvant PARP inhibitors for this population in the phase 1 NOW study (NCT03943173).

The single-arm, open-label pilot study, evaluated the feasibility of administering neoadjuvant olaparib (Lynparza) prior to surgical resection and adjuvant chemotherapy for patients with newly diagnosed BRCA-mutant ovarian, primary peritoneal, or fallopian tube cancer, Huang begins. Patients who responded to neoadjuvant olaparib proceeded to surgery, she notes. Those who did not respond to olaparib or experienced disease progression went on to receive paclitaxel and carboplatin until amenable to surgery. Both groups were given additional chemotherapy and PARP inhibitor maintenance after surgery. 

Findings from the trial showed that the 2 cycles of olaparib were well tolerated and produced a 100% optimal resection rate, Huang reports. Moreover, the estimated 12-month progression-free survival rate with olaparib was 81% at a median a follow-up of 11.7 months. Of the 14 patients who responded to neoadjuvant olaparib and subsequently underwent surgery, 85.7% achieved optimal results with no gross residual disease. Overall, results showed that the majority of patients given olaparib rather than chemotherapy were able to quickly proceed to surgery, Huang states.

Despite promising results, the replacement of chemotherapy with other non-chemotherapy agents such as PARP inhibitors is not yet possible according to the current body of research, Huang continues. Continued attempts to provide patients with oral, non-chemotherapy options are warranted, she says, and the patient population in the NOW study is of particular interest for these future investigations.