For a BRCA1+ patient with a history of stage IVB endometrioid ovarian carcinoma s/p upfront surgery and adjuvant chemotherapy who has now completed 3 years of maintenance niraparib and is NED, how would you counsel about discontinuing vs continuing PARPi therapy?

Recommendation: I recommend that this patient with Stage IVB ovarian cancer, with a complete response to surgery, chemotherapy, and 3 years of maintenance PARPi, be counseled to discontinue niraparib.

Background:

The duration of therapy for primary maintenance PARPi should be tailored based on the ass...

For this patient who has completed 3 years of niraparib and is NED, discontinuation is reasonable and supported by available evidence. The PFS benefit achieved will likely persist for years after stopping, while continuing exposes her to cumulative toxicity risks without a proven incremental benefit...

I have a real-life case exactly matching this situation. After completion of 3 years of niraparib as NED and a CA-125 level of 6.6, we discussed the available data and discontinued niraparib. During the follow-ups, at 8 months, CA-125 was 8.8, at 12 months, 15, at 14 months, 22.4, and at 17 months, ...