Using PARP Inhibitors in the Treatment of Patients With Ovarian Cancer
Use of poly(ADP-ribose) polymerase (PARP) inhibitors has greatly increased over the past 5 years. With several new Food and Drug Administration (FDA) approvals, three PARP inhibitors have entered into standard of care treatment for epithelial ovarian cancer (including ovarian, fallopian tube, and primary peritoneal cancer). Olaparib and rucaparib currently have indications for treatment of recurrent BRCA mutant ovarian cancer. Olaparib, rucaparib, and niraparib all have indications for maintenance therapy in recurrent platinum-sensitive ovarian cancer after response to platinum-based therapy. In our practice, we use both olaparib and rucaparib in the recurrent setting, and all three PARP inhibitors in the maintenance setting. Choice of which PARP inhibitor to use in either setting is largely based upon baseline laboratory values, number of prior therapies, and presence of a BRCA mutation and/or homologous recombination deficiency (HRD). As (HRD) and other biomarker assessments continue to improve, we anticipate being able to better identify which patients might most benefit from PARP inhibitor therapy in the future. The clinically available PARP inhibitors are currently undergoing extensive investigations in clinical trials. Other newer agents such as talazoparib, veliparib, 2X-121, and CEP-9722 are in earlier stages of development. As more FDA-approved indications for PARP inhibitor therapy in ovarian cancer become available, we anticipate the decision of which PARP inhibitor to use will become increasingly complex.
KeywordsOvarian cancer PARP inhibitors Targeted therapy Treatment Maintenance
This study is supported by NIH T32 Training Grant (5 T32 CA101642 02) NIH SPORE in Ovarian Cancer (NIH 2P50 CA109298), NIH MD Anderson Cancer Center Support Grant (P30CA016672), and Judy Reis/Al Pisani Ovarian Cancer Research Fund, CPRIT RP120214; SNW is supported by the Andrew Sabin Family Fellowship; RLC is supported by the Ann Rife Cox Chair in Gynecology.
Compliance with Ethical Standards
Conflict of Interest
Katherine Kurnit declares that she has no conflict of interest.
Robert L. Coleman has received research funding through grants from the National Institutes of Health (NIH), the Gateway Fondation, and the V Foundation; has also received research support from AstraZeneca, Merck, Clovis, Genmab, Roche/Genentech, and Janssen; and has received compensation from AstraZeneca, Tesaro, Medivation, Clovis, GamaMabs, Genmab, Roche/Genentech, Janssen, Agenus, Regeneron, and OncoQuest for service as a consultant.
Shannon N. Westin has received research funding through grants from the NIH and the Andrew Sabin Family Fellowship; has also received research support from AstraZeneca, Tesaro, and Cotinga Pharmaceuticals; and has received compensation from AstraZeneca, Merck, Tesaro, Medivation, Clovis, Casdin Capital, Ovation, and Roche/Genentech for service as a consultant.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
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