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Additional Considerations: PARPs for EOC in Practice

Panelists: Bradley J. Monk, MD, FACS, FACOG, University of Arizona, Creighton University, & Arizona Oncology Practice of US Oncology; Ursula Matulonis, MD, Dana-Farber Cancer Institute; David OMalley, MD, The Ohio State University; Matthew Powell, MD, Washington University; Shannon N. Westin, MD, MPH, MD Anderson Cancer Center
Published: Thursday, Apr 26, 2018



Transcript: 

Bradley J. Monk, MD, FACS, FACOG:
Maintenance olaparib in the second-line or beyond setting. Maintenance niraparib in the second-line and beyond setting. Maintenance rucaparib for second-line and beyond—it’s coming any second. So, that’s interesting. Treatment—rucaparib. Treatment—olaparib. Ursula, you and I worked very hard on treatment with niraparib?

Ursula Matulonis, MD: Correct.

Bradley J. Monk, MD, FACS, FACOG: We’ve submitted treatment with niraparib to ASCO. You’re aware that we’ve also submitted secondary cytoreduction in ovarian cancer to ASCO? And then, you also said that we have the GOG-0218 overall survival data. So, all of a sudden, we have a lot of anticipation for ASCO. This is really exciting.

David O’Malley, MD: Again, the somatic mutation of BRCA is a very important point. We now have biomarkers that we can use.

Bradley J. Monk, MD, FACS, FACOG: Do the somatics do differently than the germlines?

David O’Malley, MD: They perform exactly the same, actually.

Bradley J. Monk, MD, FACS, FACOG: Thank you very much. That’s right.

Shannon N. Westin, MD, MPH: Weren’t they included for ARIEL3? They were included in the germline? It’s a little different there, between ARIEL3 and….

David O’Malley, MD: Correct, so it’s just called a BRCA mutation.

Bradley J. Monk, MD, FACS, FACOG: Every study gets better.

Ursula Matulonis, MD: It’s the same with SOLO2.

Bradley J. Monk, MD, FACS, FACOG: In Ursula’s NOVA trial, they divided it up. In ARIEL3, they said, “Well, we checked it and we actually put the somatics with the germlines because they’re the same.” So, the studies get better as we go, but I don’t think the conclusions necessarily change.

Shannon N. Westin, MD, MPH: Right.

Ursula Matulonis, MD: Right.

Bradley J. Monk, MD, FACS, FACOG: I think it’s disingenuous, a little bit, to say, “Study 19 was bad because it’s older.” It’s a different era.

Matthew Powell, MD: I mean, thank goodness that drug didn’t die. Just think what could happen based on small, little....

Bradley J. Monk, MD, FACS, FACOG: One of the reasons that the drug could have died was because of the fear of myelodysplastic syndrome. Although it has increased a small amount, the patients also do better. And so, they’re watched closer. So, we haven’t stopped a single study based on an MDS or AML signal.

David O’Malley, MD: But also, the previous platinum exposure increases your risk of MDS. These patients are living longer. The somatic and germline patients are living longer with more platinum exposure. They’re going to have a higher occurrence of MDS. I’m not sure if there actually is a real increase in exposure.

Transcript Edited for Clarity

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Transcript: 

Bradley J. Monk, MD, FACS, FACOG:
Maintenance olaparib in the second-line or beyond setting. Maintenance niraparib in the second-line and beyond setting. Maintenance rucaparib for second-line and beyond—it’s coming any second. So, that’s interesting. Treatment—rucaparib. Treatment—olaparib. Ursula, you and I worked very hard on treatment with niraparib?

Ursula Matulonis, MD: Correct.

Bradley J. Monk, MD, FACS, FACOG: We’ve submitted treatment with niraparib to ASCO. You’re aware that we’ve also submitted secondary cytoreduction in ovarian cancer to ASCO? And then, you also said that we have the GOG-0218 overall survival data. So, all of a sudden, we have a lot of anticipation for ASCO. This is really exciting.

David O’Malley, MD: Again, the somatic mutation of BRCA is a very important point. We now have biomarkers that we can use.

Bradley J. Monk, MD, FACS, FACOG: Do the somatics do differently than the germlines?

David O’Malley, MD: They perform exactly the same, actually.

Bradley J. Monk, MD, FACS, FACOG: Thank you very much. That’s right.

Shannon N. Westin, MD, MPH: Weren’t they included for ARIEL3? They were included in the germline? It’s a little different there, between ARIEL3 and….

David O’Malley, MD: Correct, so it’s just called a BRCA mutation.

Bradley J. Monk, MD, FACS, FACOG: Every study gets better.

Ursula Matulonis, MD: It’s the same with SOLO2.

Bradley J. Monk, MD, FACS, FACOG: In Ursula’s NOVA trial, they divided it up. In ARIEL3, they said, “Well, we checked it and we actually put the somatics with the germlines because they’re the same.” So, the studies get better as we go, but I don’t think the conclusions necessarily change.

Shannon N. Westin, MD, MPH: Right.

Ursula Matulonis, MD: Right.

Bradley J. Monk, MD, FACS, FACOG: I think it’s disingenuous, a little bit, to say, “Study 19 was bad because it’s older.” It’s a different era.

Matthew Powell, MD: I mean, thank goodness that drug didn’t die. Just think what could happen based on small, little....

Bradley J. Monk, MD, FACS, FACOG: One of the reasons that the drug could have died was because of the fear of myelodysplastic syndrome. Although it has increased a small amount, the patients also do better. And so, they’re watched closer. So, we haven’t stopped a single study based on an MDS or AML signal.

David O’Malley, MD: But also, the previous platinum exposure increases your risk of MDS. These patients are living longer. The somatic and germline patients are living longer with more platinum exposure. They’re going to have a higher occurrence of MDS. I’m not sure if there actually is a real increase in exposure.

Transcript Edited for Clarity
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