ASCO Guideline for Using PARP Inhibitors to Manage Ovarian Cancer
Posted: Thursday, August 20, 2020
With multiple underlying causes of ovarian cancer, different PARP inhibitors may be appropriate for different etiologies. An expert panel, led by Elise C. Kohn, MD, of the National Cancer Institute, and William P. Tew, MD, of Memorial Sloan Kettering Cancer Center, released an ASCO guideline for treating patients with epithelial ovarian, tubal, or primarily peritoneal cancer with PARP inhibitors, which was published in the Journal of Clinical Oncology.
A total of 17 randomized, controlled, open-labeled clinical trials from 2011 to 2020 served as the basis of the evidence for the guideline. Five guiding questions were used to develop the recommendations; these questions covered toxicity, dosage, histologic types of disease, and combination of PARP inhibitors with other types of therapies. The recommendations were rated by strength of evidence.
The panels provided recommendations for patients newly diagnosed with epithelial ovarian, tubal, or primary peritoneal cancer who were PARP inhibitor–naive; PARP inhibitors were suggested solely for patients with late-stage (stage III or IV) cancer, not early-stage (I or II) cancer. Furthermore, patients with epithelial ovarian cancer qualified for PARP inhibitors if they have responded to platinum-based therapy.
Patients who have responded to platinum-based therapy may be eligible for single-agent PARP inhibition as maintenance therapy. Niraparib is indicated for patients with high-grade serous or endometrioid epithelial ovarian cancer , whereas olaparib is indicated for those with either germline or somatic BRCA1/2 mutation, according to the guideline. Olaparib can also be added to bevacizumab to treat patients who have had a partial or complete response to combined bevacizumab and chemotherapy.
Repetition of PARP inhibition is not recommended at this time nor is combining PARP inhibitors with chemotherapy, immune-oncology, or targeted agents, except in clinical trials. The guideline also included recommendations for managing adverse reactions. It is advised to continue treatment with PARP inhibitors until disease progresses or toxicity is observed.
For full guidelines, see link below.
Disclosure: For full disclosures of panel members, visit ascopubs.org.
