Practice Statement on Frontline PARPi Maintenance Therapy in Ovarian Cancer Published
As published in the October 2020 Gynecologic Oncology article, “Frontline PARP inhibitor maintenance therapy in ovarian cancer: A Society of Gynecologic Oncology practice statement,” recent data from four randomized phase 3 trials have established an important role for frontline PARP inhibitor (PARPi) maintenance therapy in ovarian cancer. While the SOLO-1 clinical trial only included patients with BRCA mutations, the PRIMA, VELIA, and PAOLA-1 trials enrolled broader patient populations. This practice statement, authored by Bhavana Pothuri, MD; Roisin O’Cearbhaill, MD; Ramez Eskander, MD and Deborah Armstrong, MD, notes that “recent FDA approvals of PARPi in the maintenance setting will enable clinicians to incorporate these into frontline armamentarium of ovarian cancer treatment.”
“These studies establish a new standard of care for women with ovarian, fallopian tube, and peritoneal cancer who have had a response to platinum-based therapy,” said lead author Dr. Pothuri. “Olaparib is National Comprehensive Cancer Network (NCCN)-listed as a maintenance option after front-line therapy in BRCA mutation carriers. Niraparib is currently listed on NCCN as a maintenance option following front line therapy regardless of BRCA mutation status.”
Dr. Pothuri added that since the recent FDA approval, the American Society of Clinical Oncology (ASCO) published guidelines for PARPi use in the Journal of Clinical Oncology in August 2020, stating that “All patients with newly diagnosed stage III-IV EOC (with serous or endometrioid histology) whose disease is in complete or partial response to first- line, platinum based chemotherapy should be offered PARPi maintenance therapy with niraparib.”
In the summary of the article, the authors note that “Many important questions such as choice of PARP inhibitor, when to utilize combination therapy with bevacizumab, role of Homologous Recombination Deficiency (HRD) testing, optimal treatment of the HR proficient patient and cost/benefit remain unanswered and/or controversial and areas of needed future investigation.”
“All of these questions are important and a real area of unmet need is the treatment of the HR proficient patient,” said Dr. Pothuri. “Clinical trials addressing the HR proficient subgroup are currently being designed.”
Dr. Pothuri added that it is important to test all patients for germline and somatic BRCA mutations due to the significant benefit seen in BRCA patients with frontline PARPi use (noted in the PRIMA, VELIA, and PAOLA-1 studies) in addition to implications for cancer risk and screening in patients as well as their families.
“It is important for clinicians to offer PARPi therapy as maintenance after frontline chemotherapy to patients, particularly those who have BRCA mutations or have HRD,” she said. “It will take education and outreach to all physicians caring for women with gynecologic cancer to adopt these new therapies in the frontline setting.”