Dr. Puechl on Choosing Between PARP Inhibitors in Ovarian Cancer

Allison M. Puechl, MD, a gynecologic oncologist at Levine Cancer Institute, Atrium Health, discusses choosing between PARP inhibitors in ovarian cancer.

Currently, 3 PARP inhibitors, olaparib (Lynparza), niraparib (Zejula), and rucaparib (Rubraca), are approved for the maintenance treatment of patients with recurrent ovarian cancer. However, without head-to-head data, selecting between the 3 agents poses a specific challenge in this space, Puechl explains. Moreover, cross-trial comparison is discouraged, particular because the inclusion criteria were different for each study.

As such, treatment selection is largely based on physician preference, patient characteristics, and potential toxicities with the PARP inhibitors, Puechl says. Although all PARP inhibitors can cause fatigue, nausea, vomiting, and generalized malaise, subtle differences between the agents are observed. For example, patients who have struggled with thrombocytopenia should not be considered for niraparib, which is more likely to cause thrombocytopenia compared with olaparib and rucaparib, Puechl says. However, patients may prefer daily dosing with niraparib to twice daily dosing with olaparib and rucaparib. Ultimately, taking patient preference and tolerability into account is important before switching a patient to another agent, concludes Puechl.