The Future Role of PARP Inhibition in Ovarian Cancer

Nov 20, 2017


Oliver Dorigo, MD, PhD: I’m personally very excited about having this extremely valuable treatment strategy of PARP inhibition available for our patients, not only at my institution but hopefully very soon worldwide. I think we have seen some very exciting data from a number of different clinical trials in the United States and in Europe. The FDA has embraced PARP inhibition in, I think, an unprecedented way, granting approval for these PARP inhibitors much faster than we have seen before. Going back in time, ovarian cancer treatment hasn’t really changed very much over the past 20 years. We had the addition of taxanes in the 1990s, and we included drugs like doxorubicin and topotecan at some point, but there hasn’t really been a meaningful drug approval for ovarian cancer until we had bevacizumab and now PARP inhibitors. So, in that sense, I think we will see more exciting data out of PARP inhibition. We need to understand much more about the molecular predictors to response. We need to identify those patients who truly benefit from PARP inhibition.

I personally think that we will soon move those PARP inhibitors into frontline treatment. We are awaiting trial results from the PRIMA trial. We have other PARP inhibitors in development, such as veliparib, that we didn’t mention today. It is a PARP inhibitor. It’s been investigated as maintenance therapy. It’s now being investigated in first-line treatment. Patients who have newly diagnosed ovarian cancer are being randomized to carboplatin/Taxol (paclitaxel) plus or minus veliparib, which will be continued as a maintenance drug. Those are exciting approaches that might possibly decrease the risk of recurrence in patients. If we can achieve this with PARP inhibition, we are likely going to see, over time, an increase in overall survival. That’s really what we need for our patients.

Matthew Powell, MD: This is a very exciting time for managing our patients with ovarian cancer. We finally have some new options, and these have been quite exciting and a long time coming. In fact, we almost lost the development of PARP inhibitors early on, and I’m very glad that the science persevered and has led to now 3 drugs able to be used for our patients with ovarian cancer. It’s really exciting. They have good single-agent activity and good tolerability, and hopefully we can start to think about how best to, and when to, treat these patients.

A lot of what we talked about is opinion based at this point. We hope to put more science behind that as we move forward, really understanding who is the best patient to do PARP inhibition with, even for first-line therapy. Those trials will be coming out in the near future, helping us to really understand whether our germline BRCA patients would benefit from PARP inhibitors at the onset and whether that may hopefully lead to more people actually cured of this disease. The combinations that we mentioned with immunotherapy and antivascular therapy appear to be very promising and hopefully will provide minimal toxicity for our patients with these diseases and give the best quality of life for as long as it can be upheld.

Transcript Edited for Clarity

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