Expert oncologists review the current PARP inhibitor treatment indications for patients with advanced ovarian cancer and discuss how to best manage patients who have been impacted by the recent updates to the PARP inhibitors.
Robert L. Coleman, MD, FACOG, FACS: Brad, maybe we could talk more about what we have available to us in the recurrent setting now that some of these PARP treatment indications and PARP maintenance indications in the platinum-sensitive space have been retracted. What do we do? Do we have anything else to use?
Bradley J. Monk, MD, FACOG, FACS: Yes. First, olaparib hasn’t gone anywhere. We’ve talked about this a little and we’ll talk about it some more. Study 19 (NCT00753545) published in the New England Journal of Medicine will always be there. There is no survival decrement, and that’s exciting. SOLO2 (NCT01874353) is there, just like NOVA (NCT01847274) and ARIEL3 (NCT01968213) for the BRCA-mutated patient. I want to make this key point: If a patient is getting the medication, even if the indication has been removed, don’t stop them. The retractions make it very clear that this is for new starts, so don’t switch medications, and keep things going if it’s tolerating and working. That’s one of the tenets of solid tumor oncology.
Robert L. Coleman, MD, FACOG, FACS: Absolutely. With respect to alternative treatments. If you go to the NCCN [National Comprehensive Cancer Network] guidelines, you’ll see there’s a densely packed table that has potential options that include not only platinum, which is an active drug in the platinum-resistant space, but also all the taxane molecules. We have several different regimens that have been studied over the years that have modest activity, so it’s no shortage of options, but we’re looking for good options. That’s why we emphasize the clinical trial component of this because this is the way that we change the narrative on what we should be able to offer to patients. We’re hopeful that with the addition of bevacizumab, which can be used more than once in patients who meet the indications for it, it can be given with chemotherapy, which will augment its objective response rate and its progression-free survival opportunity. We have options for patients now. Even though the PARP inhibitors, for the most part, have been taken out of the treatment indication, we have the opportunity of using olaparib as a maintenance strategy in patients who hadn’t received it before. I know I share the enthusiasm to continue to try to move this narrative forward by participating in clinical trials because that’s our best option to redefine the space.
Transcript edited for clarity.