Dr Elias on the Role of Olaparib Maintenance Therapy For BRCA1/2-Mutated Ovarian Cancer

“Olaparib is still one of our treatments of choice for women with somatic or germline BRCA mutations who have just finished primary therapy. We have the longest [follow-up for] safety and efficacy data with olaparib compared with other PARP inhibitors, and we know that for this subgroup of patients, the benefit [with olaparib] is tremendous.”

Kevin Elias, MD, the Lillian and Seth Harris Endowed Chair for Ovarian Cancer Research at the Cleveland Clinic, emphasized the foundational role of olaparib (Lynparza) as maintenance therapy for patients with advanced ovarian cancer harboring somatic or germline BRCA1 or BRCA2 mutations following completion of primary therapy.

Among available PARP inhibitors, olaparib has the most mature safety and efficacy data, with durable benefit demonstrated through long-term follow-up.
Elias referenced the 7-year overall survival (OS) data from the phase 3 SOLO-1 trial (NCT01844986), which solidified olaparib’s role in this population. At 7 years from randomization, the risk of death was 33% among patients who received maintenance olaparib vs 53.5% among those who received placebo. Nearly half of patients treated with olaparib remained alive and recurrence-free at seven years, compared with only 20% of patients in the placebo arm who remained progression-free or alive during that period. These findings underscore the sustained benefit of early PARP inhibition in prolonging disease control and survival for patients with BRCA-mutated ovarian cancer, Elias said.

Elias noted that these data reinforce the clinical imperative of comprehensive molecular testing at diagnosis to identify patients who are most likely to derive benefit from targeted maintenance therapy. Determining BRCA1 and BRCA2 status—whether germline or somatic—early in the disease course enables prompt initiation of olaparib and ensures that eligible patients receive optimal therapy without unnecessary delay, Elias explained. Molecular stratification has therefore become integral to personalized treatment planning in ovarian cancer, aligning therapeutic decisions with underlying genomic drivers of disease, he stated.

From a clinical practice perspective, Elias highlighted that maintenance olaparib substantially alters the treatment trajectory for patients with BRCA-mutated disease. Across trials, olaparib maintenance has consistently reduced the risk of recurrence or death by more than 50% compared with placebo. He noted that these results provide strong justification for incorporating olaparib early in the management algorithm, particularly for patients who achieve a complete or partial response with platinum-based chemotherapy.

Elias concluded that the long-term survival advantage, established safety profile, and durable disease control observed with olaparib confirm its role as a cornerstone therapy in advanced ovarian cancer.