4.5 Review

PARP Inhibitors in Ovarian Cancer: A Review

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Article Oncology

Overall Survival With Maintenance Olaparib at a 7-Year Follow-Up in Patients With Newly Diagnosed Advanced Ovarian Cancer and a BRCA Mutation: The SOLO1/GOG 3004 Trial

Paul DiSilvestro et al.

Summary: Maintenance therapy with olaparib showed sustained progression-free survival benefit in newly diagnosed advanced ovarian cancer patients with a BRCA mutation. After a 7-year follow-up, there was a clinically meaningful improvement in overall survival. The incidence of myelodysplastic syndrome and acute myeloid leukemia was low.

JOURNAL OF CLINICAL ONCOLOGY (2023)

Article Medicine, Research & Experimental

Utilization of Poly(ADP-Ribose) Polymerase Inhibitors in Ovarian Cancer: A Retrospective Cohort Study of US Healthcare Claims Data

Rebecca C. Arend et al.

Summary: This study aimed to characterize the utilization of PARP inhibitors in women with ovarian cancer in the real-world setting. Differences were observed among licensed PARPi in terms of adverse event risk, dose modifications, treatment persistence, healthcare resource utilization, and costs.

ADVANCES IN THERAPY (2022)

Article Oncology

Olaparib maintenance monotherapy in platinum-sensitive relapsed ovarian cancer patients without a germline BRCA1/BRCA2 mutation: OPINION primary analysis

A. Poveda et al.

Summary: The OPINION trial investigated the efficacy of olaparib maintenance therapy in patients without deleterious mutations. The results showed clinical benefit in all subgroups.

GYNECOLOGIC ONCOLOGY (2022)

Article Oncology

Efficacy of maintenance olaparib plus bevacizumab according to clinical risk in patients with newly diagnosed, advanced ovarian cancer in the phase III PAOLA-1/ENGOT-ov25 trial

Philipp Harter et al.

Summary: In the PAOLA-1 trial, maintenance olaparib plus bevacizumab provided a substantial PFS benefit in both higher-risk and lower-risk patients compared to bevacizumab alone. In the HRD-positive subgroup, olaparib plus bevacizumab showed significant PFS improvement in lower-risk patients.

GYNECOLOGIC ONCOLOGY (2022)

Article Medicine, Research & Experimental

Health Care Resource Utilization and Costs Associated with Disease Progression in Ovarian Cancer

Daniel Simmons et al.

Summary: This study aims to understand the healthcare resource utilization and costs of patients with advanced ovarian cancer who did not receive PARP inhibitor maintenance therapy. The study found that progression beyond first-line treatment in ovarian cancer leads to significant healthcare resource usage and high costs. Prolonging progression-free survival after first-line treatment can delay or prevent the need for later treatment, reduce financial burden on patients, and alleviate the economic burden on the healthcare system.

ADVANCES IN THERAPY (2022)

Article Oncology

Rucaparib versus standard-of-care chemotherapy in patients with relapsed ovarian cancer and a deleterious BRCA1 or BRCA2 mutation (ARIEL4): an international, open-label, randomised, phase 3 trial

Rebecca Kristeleit et al.

Summary: In patients with BRCA1 or BRCA2 mutated ovarian carcinoma, rucaparib demonstrated better progression-free survival compared to chemotherapy. The results of this study support rucaparib as an alternative treatment option for patients with relapsed BRCA-mutated ovarian carcinoma.

LANCET ONCOLOGY (2022)

Article Oncology

Olaparib treatment for platinum-sensitive relapsed ovarian cancer by BRCA mutation and homologous recombination deficiency status: Phase II LIGHT study primary analysis

Karen Cadoo et al.

Summary: In this study, olaparib treatment demonstrated efficacy in patients with PSROC, showing effectiveness in not only BRCAm patients but also HRD-positive non-BRCAm patients, with a good safety profile.

GYNECOLOGIC ONCOLOGY (2022)

Article Oncology

OVARIO phase II trial of combination niraparib plus bevacizumab maintenance therapy in advanced ovarian cancer following first-line platinum-based chemotherapy with bevacizumab

Melissa M. Hardesty et al.

Summary: This study evaluated the safety and efficacy of Niraparib + bevacizumab as a first-line maintenance therapy for newly diagnosed advanced ovarian cancer patients. The results showed promising PFS outcomes and the safety profile was consistent with the monotherapy of these drugs.

GYNECOLOGIC ONCOLOGY (2022)

Article Oncology

A Randomized, Phase III Trial to Evaluate Rucaparib Monotherapy as Maintenance Treatment in Patients With Newly Diagnosed Ovarian Cancer (ATHENA-MONO/GOG-3020/ENGOT-ov45)

Bradley J. Monk et al.

Summary: This study evaluates the efficacy of rucaparib as a first-line maintenance treatment in ovarian cancer patients, showing significant benefits of rucaparib compared to placebo in patients with and without HRD.

JOURNAL OF CLINICAL ONCOLOGY (2022)

Meeting Abstract Oncology

PRIMA/ENGOT-OV26/GOG-3012 study: Updated long-term PFS and safety

A. J. Gonzalez Martin et al.

ANNALS OF ONCOLOGY (2022)

Article Oncology

Maintenance olaparib plus bevacizumab in patients with newly diagnosed advanced high-grade ovarian cancer: Main analysis of second progression-free survival in the phase III PAOLA-1/ENGOT-ov25 trial

Antonio Gonzalez-Martin et al.

Summary: Maintenance olaparib plus bevacizumab provided continued benefit beyond first progression in newly diagnosed, advanced ovarian cancer, with a significant improvement in PFS2 and a delay in time to second subsequent therapy or death compared to placebo plus bevacizumab.

EUROPEAN JOURNAL OF CANCER (2022)

Article Oncology

Clinical and molecular characteristics of ARIEL3 patients who derived exceptional benefit from rucaparib maintenance treatment for high-grade ovarian carcinoma

David M. O'Malley et al.

Summary: This study explored the clinical and molecular characteristics associated with exceptional benefit from the PARP inhibitor rucaparib in patients with recurrent high-grade ovarian carcinoma. The results showed that patients with favorable baseline clinical characteristics and molecular evidence of homologous recombination deficiency were more likely to derive exceptional benefit from rucaparib.

GYNECOLOGIC ONCOLOGY (2022)

Article Oncology

A meta-analysis of reversion mutations in BRCA genes identifies signatures of DNA end-joining repair mechanisms driving therapy resistance

L. Tobalina et al.

Summary: Germline mutations in BRCA1 or BRCA2 genes predispose to hereditary breast and ovarian cancer. Tumours from these patients are sensitive to platinum drugs and PARPi treatments. Some patients develop reversion mutations capable of restoring BRCA protein expression, mainly in DNA repair pathways. Identifying and targeting these pathways could improve treatment durability and offer new therapeutic opportunities.

ANNALS OF ONCOLOGY (2021)

Article Oncology

Niraparib maintenance therapy in patients with platinum-sensitive recurrent ovarian cancer using an individualized starting dose (NORA): a randomized, double-blind, placebo-controlled phase III trial

X. H. Wu et al.

Summary: This study demonstrated that maintenance treatment with niraparib significantly reduced the risk of disease progression or death in patients with platinum-sensitive recurrent ovarian cancer, and prolonged progression-free survival compared to placebo. Individualized dosing of niraparib was found to be effective and safe, and should be considered standard practice in this setting.

ANNALS OF ONCOLOGY (2021)

Review Oncology

The Clinical Challenges, Trials, and Errors of Combatting Poly(ADP-Ribose) Polymerase Inhibitors Resistance

Melissa M. Pham et al.

Summary: The use of PARPi in solid tumors with HRR defects has shown clinical benefit in BRCA1/2 mutated and BRCAness tumors, but limited treatment durability. Molecular mechanisms of PARPi resistance include HRR function restoration, replication fork stabilization, BRCA1/2 reversion mutations, and epigenetic changes.

CANCER JOURNAL (2021)

Article Oncology

Concordance Between Tumor and Germline BRCA Status in High-Grade Ovarian Carcinoma Patients in the Phase III PAOLA-1/ENGOT-ov25 Trial

Celine Callens et al.

Summary: The PAOLA1 study evaluated the effectiveness of olaparib maintenance therapy in advanced high-grade ovarian carcinoma patients, with tBRCA testing showing to be a reliable tool with an acceptable turnaround time and low failure rate. The study also found that tBRCA testing revealed pathogenic variants in some French patients that were not detected by gBRCA testing.

JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE (2021)

Article Oncology

Population-adjusted indirect treatment comparison of the SOLO1 and PAOLA-1/ENGOT-ov25 trials evaluating maintenance olaparib or bevacizumab or the combination of both in newly diagnosed, advanced BRCA-mutated ovarian cancer

Ignace Vergote et al.

Summary: In the absence of head-to-head trials, a population-adjusted indirect treatment comparison was conducted to evaluate the efficacy and safety of maintenance olaparib and bevacizumab in patients with advanced ovarian cancer and a BRCA mutation. Findings suggest that adding bevacizumab to olaparib could improve progression-free survival, and maintenance olaparib alone or in combination with bevacizumab is a recommended treatment option for newly diagnosed patients with advanced ovarian cancer and a BRCA mutation.

EUROPEAN JOURNAL OF CANCER (2021)

Article Oncology

Concordance of BRCA mutation detection in tumor versus blood, and frequency of bi-allelic loss of BRCA in tumors from patients in the phase III SOLO2 trial

Darren R. Hodgson et al.

Summary: The study demonstrates high concordance between tumor and germline BRCA testing in ovarian cancer patients, supporting wider implementation of tumor BRCA testing in the clinical setting. Near 100% rates of bi-allelic loss of BRCA in platinum-sensitive relapsed ovarian tumors suggest routine testing for BRCA zygosity may not be necessary in this population.

GYNECOLOGIC ONCOLOGY (2021)

Article Oncology

Characterization of patients with long-term responses to rucaparib treatment in recurrent ovarian cancer

Elizabeth M. Swisher et al.

Summary: The study found that a significant proportion of HGOC patients who responded to the PARP inhibitor rucaparib had long-term responses, with most of them harboring BRCA1 or BRCA2 mutations, particularly BRCA structural variants. Patients with BRCA structural variants had significantly longer duration of response compared to those with other mutation types, indicating a relationship between this specific mutation type and treatment response. Additionally, patients with high genome-wide LOH without BRCA mutations also exhibited long-term responses, suggesting potential molecular characteristics associated with treatment outcomes.

GYNECOLOGIC ONCOLOGY (2021)

Article Oncology

ATHENA (GOG-3020/ENGOT-ov45): a randomized, phase III trial to evaluate rucaparib as monotherapy (ATHENA-MONO) and rucaparib in combination with nivolumab (ATHENA-COMBO) as maintenance treatment following frontline platinum-based chemotherapy in ovarian cancer

Bradley J. Monk et al.

Summary: The study aims to evaluate the efficacy of PARP inhibitor rucaparib and immune checkpoint inhibitor nivolumab in the treatment of newly diagnosed ovarian cancer patients, as well as the effectiveness of their combined use.

INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER (2021)

Article Oncology

Maintenance olaparib for patients with newly diagnosed advanced ovarian cancer and a BRCA mutation (SOLO1/GOG 3004): 5-year follow-up of a randomised, double-blind, placebo-controlled, phase 3 trial

Susana Banerjee et al.

Summary: The study demonstrated that maintenance therapy with olaparib for 2 years can extend progression-free survival to over 4.5 years in patients with newly diagnosed advanced ovarian cancer and a BRCA mutation. These results support the use of maintenance olaparib as a standard of care in this setting.

LANCET ONCOLOGY (2021)

Review Oncology

Clinical practice guidelines for BRCA1 and BRCA2 genetic testing

Pascal Pujol et al.

Summary: BRCA1 and BRCA2 gene pathogenic variants play a crucial role in hereditary breast cancer, and updated comprehensive practice guidelines are needed for BRCA genotyping. Integrative recommendations for genetic counselling and personalized management of early and metastatic breast cancer can help clinicians optimize BRCA testing practices and standardize outcomes.

EUROPEAN JOURNAL OF CANCER (2021)

Review Oncology

Maintenance Treatment of Newly Diagnosed Advanced Ovarian Cancer: Time for a Paradigm Shift?

Paul DiSilvestro et al.

Summary: Recent data have shown significant efficacy of PARP inhibitors as treatment and/or maintenance therapy in patients with newly diagnosed advanced epithelial ovarian cancer (EOC), particularly in subgroups with genomic instability. These results have implications for current clinical practice, highlighting the importance of personalized medicine and suggesting areas for future research.

CANCERS (2021)

Article Oncology

Olaparib tablets as maintenance therapy in patients with platinum-sensitive relapsed ovarian cancer and a BRCA1/2 mutation (SOLO2/ENGOT-Ov21): a final analysis of a double-blind, randomised, placebo-controlled, phase 3 trial

Andres Poveda et al.

Summary: Olaparib provided a median overall survival benefit of 12.9 months compared with placebo in patients with platinum-sensitive, relapsed ovarian cancer and a BRCA1/2 mutation. Although statistical significance was not reached, these findings are arguably clinically meaningful and support the use of maintenance olaparib in these patients.

LANCET ONCOLOGY (2021)

Article Oncology

Patient-centred outcomes and effect of disease progression on health status in patients with newly diagnosed advanced ovarian cancer and a BRCA mutation receiving maintenance olaparib or placebo (SOLO1): a randomised, phase 3 trial

Michael Friedlander et al.

Summary: Maintenance olaparib treatment in newly diagnosed, advanced ovarian cancer patients provides a significant progression-free survival benefit without detrimental effects on HRQOL. Quality-adjusted progression-free survival and time without significant toxicity symptoms were significantly longer in the olaparib group compared to the placebo group.

LANCET ONCOLOGY (2021)

Article Multidisciplinary Sciences

Molecular and clinical determinants of response and resistance to rucaparib for recurrent ovarian cancer treatment in ARIEL2 (Parts 1 and 2)

Elizabeth M. Swisher et al.

Summary: RAD51C, RAD51D mutations, and high-level BRCA1 promoter methylation can predict response to the PARP inhibitor rucaparib, while BRCA1 methylation loss may be a major cross-resistance mechanism to platinum and PARPi.

NATURE COMMUNICATIONS (2021)

Article Oncology

Tolerability of maintenance olaparib in newly diagnosed patients with advanced ovarian cancer and a BRCA mutation in the randomized phase III SOLO1 trial

Nicoletta Colombo et al.

Summary: Maintenance olaparib in newly diagnosed advanced ovarian cancer patients showed a manageable adverse event profile, with events typically occurring early, being largely manageable, and leading to discontinuation in only a minority of patients.

GYNECOLOGIC ONCOLOGY (2021)

Article Oncology

Adherence to PARP inhibitor therapy among women with ovarian cancer

Haley A. Moss et al.

Summary: This study evaluated medical adherence for ovarian cancer patients receiving PARP inhibitor therapy and found that a quarter of patients may be sub-optimally adherent. Factors such as age, comorbidities, insurance plan, and year of PARP inhibitor initiation were not significantly associated with non-adherence. Further research should focus on identifying at-risk patients and interventions to improve adherence.

GYNECOLOGIC ONCOLOGY (2021)

Article Oncology

Germline and Somatic Tumor Testing in Epithelial Ovarian Cancer: ASCO Guideline

Panagiotis A. Konstantinopoulos et al.

JOURNAL OF CLINICAL ONCOLOGY (2020)

Article Oncology

Evaluation of an individualized starting-dose of niraparib in the PRIMA/ENGOT-OV26/GOG-3012 study.

Mansoor Raza Mirza et al.

JOURNAL OF CLINICAL ONCOLOGY (2020)

Article Oncology

Final Overall Survival of a Randomized Trial of Bevacizumab for Primary Treatment of Ovarian Cancer

Krishnansu S. Tewari et al.

JOURNAL OF CLINICAL ONCOLOGY (2019)

Article Medicine, General & Internal

Niraparib in Patients with Newly Diagnosed Advanced Ovarian Cancer

A. Gonzalez-Martin et al.

NEW ENGLAND JOURNAL OF MEDICINE (2019)

Article Medicine, General & Internal

Olaparib plus Bevacizumab as First-Line Maintenance in Ovarian Cancer

I. Ray-Coquard et al.

NEW ENGLAND JOURNAL OF MEDICINE (2019)

Article Oncology

Safety and dose modification for patients receiving niraparib

J. S. Berek et al.

ANNALS OF ONCOLOGY (2018)

Article Medicine, General & Internal

Maintenance Olaparib in Patients with Newly Diagnosed Advanced Ovarian Cancer

K. Moore et al.

NEW ENGLAND JOURNAL OF MEDICINE (2018)

Article Medicine, General & Internal

Niraparib Maintenance Therapy in Platinum-Sensitive, Recurrent Ovarian Cancer

M. R. Mirza et al.

NEW ENGLAND JOURNAL OF MEDICINE (2016)

Article Oncology

Patient Preferences in Advanced or Recurrent Ovarian Cancer

Laura J. Havrilesky et al.

CANCER (2014)

Article Medicine, General & Internal

Olaparib Maintenance Therapy in Platinum-Sensitive Relapsed Ovarian Cancer

Jonathan Ledermann et al.

NEW ENGLAND JOURNAL OF MEDICINE (2012)

Article Medicine, General & Internal

Incorporation of Bevacizumab in the Primary Treatment of Ovarian Cancer

Robert A. Burger et al.

NEW ENGLAND JOURNAL OF MEDICINE (2011)

Article Medicine, General & Internal

A Phase 3 Trial of Bevacizumab in Ovarian Cancer

Timothy J. Perren et al.

NEW ENGLAND JOURNAL OF MEDICINE (2011)