Bradley J. Monk, MD
PARP inhibitors are poised to acquire a stronger foothold in the frontline setting for advanced ovarian cancer, for which chemotherapy remains the backbone of treatment, according to a panel of gynecologic oncology experts who discussed the issue during an OncLive Peer Exchange®
held during the European Society for Medical Oncology Congress 2019 (ESMO 2019). Chemotherapy ultimately fails most patients, but PARP inhibitors, which already have multiple indications in the recurrent setting, have a greater chance at providing cure when used earlier in the lineup, the panelists said.
In ovarian cancer, PARP inhibitors have joined an increasing number of therapies in the treatment landscape, and indications for approved agents are continuing to expand as results of clinical trials show benefit in different patient subsets. Treatment decision making is therefore set to become more nuanced, particularly as investigators continue to evaluate the utility of certain biomarkers and their diagnostic assays in clinical trials.
The panelists also examined how certain biomarkers predict the efficacy of PARP inhibitors and how these agents compare with bevacizumab (Avastin), another targeted agent approved for advanced, newly diagnosed, and recurrent high-grade serous or endometrioid ovarian, primary peritoneal, or fallopian tube cancer. They also discussed a novel antibody-drug conjugate being assessed in the recurrent setting that likely would have ceased being developed had a biomarker assay error not been identified.
Although biomarkers in ovarian cancer are still being investigated, they are starting to shape care, with most indications of currently approved targeted agents requiring use of a companion diagnostic to guide patient selection. “I think we’re turning ovarian cancer into a rarer and rarer disease with these subsets, which will help us do better, smaller, smarter trials to move things forward. It’s an exciting time,” panelist Kathleen Moore, MD, said.
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