Dr. Westin on Advances Made With PARP Inhibitors in Ovarian Cancer

Shannon N. Westin, MD, MPH, an associate professor at The University of Texas MD Anderson Cancer Center, discusses advances made with PARP inhibitors in the ovarian cancer treatment paradigm.

Initial indications were approved for the PARP inhibitors olaparib (Lynparza) and rucaparib (Rubraca) in the recurrent space, says Westin, in patients who had received multiple lines of therapy but have a mutation in BRCA. These patients could be treated with either of the 2 PARP inhibitors, which are still good options for patients who are past upfront treatment, she adds.

Later, the FDA approved several indications in the recurrent setting as a maintenance strategy. These indications are for patients who had a response to platinum-based therapy in that setting and are then getting transitioned to one of the 3 PARP inhibitors that are available, she explains—namely olaparib, rucaparib, and nirapirab (Zejula).

Most recently, in December 2018, the FDA approved olaparib for use in the upfront setting, in patients who have a germline or a somatic BRCA mutation, received upfront therapy, and have had a good response. Now, these patients can be transitioned to received maintenance therapy with this PARP inhibitor.

The approval was based on positive data from the SOLO-1 (NCT01844986), a randomized, multicenter trial that compared the use of olaparib with placebo in patients with BRCA-mutated advanced ovarian, fallopian tube, or primary peritoneal cancer following first-line platinum-based chemotherapy. Results showed significant improvement in investigator-assessed progression-free survival with olaparib compared with placebo. The approval is an exciting one, says Westin, who is curious to find out how upfront treatment with a PARP inhibitor might effect what happens in later lines of therapy.

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