Dr Modesitt on Shared Decision-Making When Choosing PARP Inhibitors in Ovarian Cancer

Susan C. Modesitt, MD, FACOG, FACS, professor, Department of Gynecology and Obstetrics, director, Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Emory University School of Medicine, and a researcher with Winship Cancer Institute of Emory University, discusses the role of PARP inhibitors in the treatment of patients with ovarian cancer.

Interpretations of clinical data regarding the use of PARP inhibitors in ovarian cancer can yield varying opinions, influenced by both oncological perspectives and individual patient treatment goals, Modesitt says. However, the general consensus among oncologists is that patients who are diagnosed with ovarian cancer harboring either a somatic or genetic BRCA mutation or homologous recombination deficient (HRD) status should receive frontline PARP inhibitors, Modesitt explains.

Debate arises regarding the treatment of patients with ovarian cancer that is not HRD or does not harbor BRCA mutations, Modesitt notes. Determining the optimal sequencing of PARP inhibitor administration for these patients is nuanced, as questions remain regarding the potential benefits and limitations of using these agents upfront or delaying their use, the latter of which may decrease overall survival outcomes, Modesitt emphasizes. Findings from ongoing trials continue to contribute to the body of evidence with PARP inhibitors in ovarian cancer, with a focus on long-term safety outcomes, time to subsequent therapies, and responses to subsequent therapies, according to Modesitt. The gynecologic oncology field remains vigilant in monitoring these research developments, recognizing that the interpretation of available evidence can vary, Modesitt adds.

Furthermore, oncologists often tailor their treatment recommendations to individual patient needs and preferences, Modesitt says. Shared decision-making is pivotal, and presenting patients with data, along with the associated benefits and limitations, fosters an open dialogue regarding treatment decisions, Modesitt emphasizes. For instance, patients who may not benefit from PARP inhibitors may still be interested in trying this treatment approach, according to Modesitt. Conversely, patients who have a good chance of benefitting from these agents may decide they do not want to receive them, Modesitt notes. Although PARP inhibitors have influenced the ovarian cancer treatment paradigm and have been shown to prevent disease recurrence in many patients, oncologists should respect individual patient choices regarding their willingness to receive these agents, Modesitt concludes.