Dr. Ledermann on PARP Inhibitors in Maintenance Therapy for Ovarian Cancer

Jonathan Ledermann, MD, professor of medical oncology at UCL Cancer Institute in London, discusses the growing use of PARP inhibitors in maintenance therapy for ovarian cancer in an interview during the 2019 SGO Annual Meeting.

Maintenance therapy in ovarian cancer is a relatively new concept, Ledermann explains, and was first utilized with bevacizumab (Avastin) as maintenance following its use in combination with chemotherapy. In the recurrent disease setting, bevacizumab is used until disease progression.

Once PARP inhibitors were added to the paradigm, the initial clinical trials that showed their efficacy in a randomized trial were the studies in the maintenance setting, which demonstrated a progression-free survival benefit for all 3 PARP inhibitors—olaparib (Lynparza), rucaparib (Rubraca), and niraparib (Zejula)—irrespective of BRCA mutation status. Additionally, results of Study 19, demonstrated that there is a trend toward overall survival with maintenance olaparib, he adds.

In the management of recurrent ovarian cancer, maintenance therapy following platinum-based chemotherapy, has become a standard of care either with bevacizumab, but it is more common with a PARP inhibitor, says Ledermann. Moreover, chemotherapy has now had a lesser role in maintenance therapy, with the additions of PARP inhibitors, which are given until disease progression or the next line of treatment.

It is important to get used to this concept as well as the safety profile of these PARP inhibitors, which are manageable and patients can remain on these agents long-term, says Ledermann. Across clinical trials, 10% to 15% of patients have stopped PARP inhibitors prematurely due to toxicity.

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