Use of PARP Inhibitors for Maintenance Therapy Among Patients With Advanced Epithelial Ovarian Cancer

At the 2024 Great Debates and Updates in Women’s Oncology meeting in New York, New York, Bradley Monk, MD, FACOG, Florida Cancer Specialists & Research Institute, West Palm Beach, Florida, discussed PARP inhibitors and determining the optimal maintenance therapy for women with advanced epithelial ovarian cancer. 

Transcript:

Greetings, my name is Brad Monk. I'm a gynecologic oncologist from Florida. I work for Florida Cancer Specialists where I'm the medical director of the late phase research program, but continue to practice gynecologic oncology. 

I'm here at Great Debates in Women’s Oncology, and we had a very lively discussion about what is the optimal maintenance therapy in women with advanced epithelial ovarian cancer. And really, it came down to this: because there is a differential effect in the HRD-test positive patients, which includes BRCA, meaning that PARP inhibitors work very well in that setting, and a lesser effect in those that are biomarker negative, should all patients, regardless of biomarker status, get treated with maintenance PARP?

There are 2 opportunities there, niraparib or rucaparib. Both are NCCN and ASCO recommended, and niraparib is FDA-approved. And we had consensus, and the answer is maybe. And we call that shared decision-making.The point is, is it the hazard ratio for niraparib and rucaparib is between about 0.65, 0.68 specifically with niraparib, which is the FDA-approved option. And the discussion was, well, maybe they should get bevacizumab, similar hazard ratio, and also no biomarker. The hazard ratio for bevacizumab is 0.62.So you have these 3 options right around 0.65, rucaparib, niraparib, bevacizumab, and the HRD test negative subset because we had universal agreement.

If they're HRD test positive, you should get a laparib with [bevacizumab] or niraparib or rucaparib. You had 3 options. But it's the biomarker negative that's the controversy. And this is the opportunity to talk to your patient. patient. We did agree, though, that just observation in this subset of patients where 80% are going to recur is a bad option. Moving forward, yes, talk to your patient. Yes, offer maintenance treatment in the biomarker negative HRD-test negative subset. And whether that is rucaparib or niraparib, a PARP inhibitor, or bevacizumab, the answer is yes.

Discuss it with your patients. Hopefully you'll listen to our debate, read the literature, and thank you for joining me today.

Source: 

Monk B. PARPi is justified for all in front line. Presented at Great Debates and Updates in Women’s Oncology; May 3-4, 2024; New York, NY.