Laura J. Chambers, DO, discusses the importance of treatment counseling for patients with ovarian cancer considering PARP inhibitor therapy.

Dr Chambers on the Importance of Patient Counseling in Ovarian Cancer

Laura J. Chambers, DO, assistant professor, Division of Gynecologic Oncology, The Ohio State University, The Ohio State Comprehensive Cancer Center—James Cancer Hospital and Solove Research Institute, discusses the importance of treatment counseling for patients with ovarian cancer considering PARP inhibitor therapy.

Patient counseling is an essential part of the decision-making process when considering the use of PARP inhibitors, particularly given the nuanced benefits depending on a patient’s tumor biology, Chambers begins. The most substantial clinical advantage of PARP inhibitors is observed in patients whose tumors exhibit homologous recombination deficiency (HRD) or 

 mutations, she states. In these patients, PARP inhibitors have shown significant efficacy, often prolonging progression-free survival (PFS). However, patients who are homologous recombination proficient tend to experience more modest benefit—typically in the range of an additional 3 to 4 months of PFS, Chambers details. This limited improvement needs to be weighed carefully against the potential burdens of treatment, she says.

The adverse effects (AEs) associated with PARP inhibitors, which may include fatigue, nausea, anemia, and the need for frequent blood tests, can be significant, particularly for those who may only see marginal benefits, Chambers continues. She adds that the financial cost of ongoing therapy can be a major factor for patients. Accordingly, it’s important to have honest and thorough discussions with patients about where they fall within the spectrum of treatment benefit and the realistic expectations for their outcomes, Chambers states. This includes being upfront about the potential for AEs, especially as the data suggest that PARP inhibitors may offer little to no benefit in later lines, Chambers notes.

Rather than introducing these discussions at the end of chemotherapy, when patients are often overwhelmed, it is important to engage in ongoing conversations throughout their treatment, Chambers emphasizes. By gradually building on these discussions during regular clinic visits, patients have the time and space to process information, understand their treatment options, and make informed decisions. This approach fosters a stronger sense of partnership in care and ensures that patients feel more prepared and supported as they transition into maintenance therapy with PARP inhibitors, Chambers concludes.

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Dr Chambers on Access, Toxicities, and Long-term Considerations for PARP Inhibitors in Ovarian Cancer

Laura J. Chambers, DO, assistant professor, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center—James, addresses the challenges patients with ovarian cancer face in accessing PARP inhibitors, emphasizing the need for careful patient evaluation and management.

Chambers explains that although PARP inhibitors are valuable in the treatment and maintenance of ovarian cancer, financial toxicity remains a significant barrier to patient access. Despite FDA-approved indications, many patients encounter high out-of-pocket costs due to inadequate insurance coverage, she says. This financial burden, coupled with the existing challenges of ongoing cancer treatment, can complicate access to these therapies for some patients, she notes.

In addition to financial toxicity, Chambers discusses the management of common adverse effects (AEs) associated with PARP inhibitors, including hematologic toxicities such as thrombocytopenia and anemia, as well as gastrointestinal AEs and fatigue. Although these toxicities are typically manageable, maintaining a good quality of life for patients during prolonged maintenance therapy is critical, Chambers explains.

Moreover, Chambers expresses concerns about the impact PARP inhibitors may have on subsequent treatment efficacy, specifically highlighting the potential for these agents to induce resistance to platinum-based chemotherapy—the cornerstone of ovarian cancer treatment. She underscores that emerging data from trials such as the 

phase 3 OReO/ENGOT Ov-38 trial (NCT03106987)

 suggest that PARP inhibitors could make tumors more resistant to platinum-based chemotherapy, thus complicating future treatment decisions and affecting overall outcomes.

Chambers advises that careful patient selection and ongoing assessment are essential to optimize the benefits of PARP inhibitors without exposing patients to unnecessary AEs if they may not benefit from the treatment. Transparent discussions between clinicians and patients regarding the expected benefits, potential toxicities, and financial implications of PARP maintenance therapy are crucial, she says. By setting realistic expectations, oncologists can help patients make informed decisions that align with their treatment goals and individual circumstances, Chambers concludes.

Laura J. Chambers, DO, discusses challenges patients with ovarian cancer face in accessing PARP inhibitor treatment. 

Dr Chambers on the Role of Genetic Testing and PARP Inhibitors in Ovarian Cancer

Laura J. Chambers, DO, assistant professor, Division of Gynecologic Oncology, The Ohio State University, The Ohio State Comprehensive Cancer Center—James, discusses the role of genetic testing on treatment decisions regarding PARP inhibitor maintenance therapy for patients with ovarian cancer.

Chambers emphasizes that all patients with ovarian cancer should be referred for genetic counseling and undergo both germline and somatic testing at the time of diagnosis. Identifying genetic mutations early in the course of treatment can help oncologists determine the most appropriate maintenance options, which can significantly affect long-term outcomes, Chambers adds.

In addition to genetic testing, Chambers notes the need for early and ongoing discussions between clinicians and patients about maintenance therapy with PARP inhibitors, rather than waiting until the end of chemotherapy. Introducing the concept of maintenance therapy at the time of diagnosis allows patients to mentally prepare for the possibility of continuing treatment beyond initial chemotherapy, which she explains is important since maintenance therapy could last several years. Chambers expresses that setting realistic expectations early on can reduce the likelihood of patients being surprised or overwhelmed by the continuation of therapy.

Additionally, Chambers highlights the importance of having candid conversations with patients about the potential benefits and limitations of maintenance therapy. Although PARP inhibitor maintenance therapy has helped improve outcomes for patients with ovarian cancer, Chambers explains benefit is usually seen after 3 to 4 months of treatment.

Given the frequent blood draws and financial costs associated with PARP maintenance therapy, Chambers advises clinicians to be transparent with patients about the likely outcomes and to discuss the risks and benefits in the context of their specific disease.

By engaging patients in ongoing conversations from the outset of their diagnosis, clinicians can help them navigate the complexities of long-term treatment, setting realistic expectations that can enhance a patient's understanding and preparedness and help optimize treatment adherence and outcomes, ultimately leading to better patient care, Chambers concludes.

Laura J. Chambers, DO, discusses the role of genetic testing and PARP inhibitor maintenance therapy for patients with ovarian cancer.

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 

 mutations, olaparib is often preferred, highlighting the personalized approach to treatment selection based on genetic and clinical factors, Chambers concludes.

Laura J Chambers, DO, discusses currently approved PARP inhibitors that are considered for use in ovarian cancer.

Laura J Chambers, DO

Articles

Dr Chambers on the Importance of Patient Counseling in Ovarian Cancer

Dr Chambers on Access, Toxicities, and Long-term Considerations for PARP Inhibitors in Ovarian Cancer

Dr Chambers on the Role of Genetic Testing and PARP Inhibitors in Ovarian Cancer

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