Dr DeBernardo on the Role of PARP Inhibitors in Frontline Ovarian Cancer

Robert DeBernardo, MD, section head, Department of Gynecologic Oncology, leader, Section of Gynecologic Oncology, director, Peritoneal Surface Malignancy Program, Laura J. Fogarty Endowed Chair in Uterine Cancer Research, Cleveland Clinic, discusses the current role of PARP inhibitors in the frontline treatment landscape in ovarian cancer, and the importance of discussing the risk/benefit profile of these agents with patients when determining a treatment approach.

PARP inhibition has emerged as a pivotal therapeutic approach in the management of ovarian cancer, DeBernardo begins. Although research with PARP inhibitors primarily focuses on assessing progression-free survival benefit, this measure may not have accurately captured the efficacy of this drug class in recurrent disease. Accordingly, DeBernardo asserts that there still may be a crucial role for these agents in the up-front setting. Specifically, PARP inhibitors have demonstrated significant benefit in a subset of patients with ovarian cancer, including those with BRCA and other homologous recombination deficient mutations, DeBernardo explains.

It's imperative for clinicians to engage in candid discussions with their patients regarding the risks and benefits associated with PARP inhibition, DeBernardo continues. These agents can offer potential advantages, such as improved outcomes, he says. However, they also come with a risk of adverse effects, including the potential development of myelodysplastic syndrome (MDS). Addressing these considerations comprehensively ensures that patients are informed about the potential long-term implications of treatment, DeBernardo states.

Moreover, the practical aspects of PARP inhibition should not be overlooked, DeBernardo notes. Following surgery and chemotherapy, patients may experience fatigue and a desire to conclude treatment. Therefore, the decision to proceed with PARP inhibition should be weighed carefully, taking into account the patient's preferences and overall quality of life, DeBernardo says.

Ultimately, the goal should be to provide personalized care that aligns with the patient's values and preferences, DeBernardo emphasizes. By engaging in open communication and considering the broader context of the patient's journey, clinicians can make well-informed decisions that prioritize the patient's well-being while effectively managing their ovarian cancer, DeBernardo concludes.