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How are you counseling HR-proficient ovarian cancer patients about front line PARP inhibitor maintenance?

Given recent approval of niraparib (Zejula) for the maintenance treatment of adult patients with advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in a complete or partial response to first-line platinum-based chemotherapy
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What are your recommendations for HR-proficient advanced ovarian cancer patients after completion of adjuvant therapy with PR/CR?

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2 Answers
Mednet MemberInvited Expert
Medical Oncology · University of Pittsburgh Magee Womens Hospital
Answered on

I think this is a tough decision, but I recommend observation for patients with HR proficient disease. In brief, I don't find a PFS advantage, without a proven OS advantage, enough to justify this long-term, expensive, and not non-toxic treatment.

For BRCA carriers the answer is easier—with SOLO2 (2020 ASCO Annual Meeting. Abstract 6002) and Ariel 3 (https://www.ncbi.nlm.nih.gov/pubmed/32359490) follow up, we now know there is a clear OS advantage/advantage in TFST, PFS2 etc advantage. This is im...

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Mednet MemberInvited Expert
Gynecologic Oncology · Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
Answered on

It’s truly exciting to have new FDA approvals in ovarian cancer. Both the PRIMA trial (González-Martín et al, NEJM 2019) and the PAOLO trial (Ray-Coquard et al NEJM 2019) have led to recent approvals for front-line maintenance therapies. When comparing data for the current front-line maintenance options in ovarian cancer, I think it is important to look at both these trials as well as SOLO-1 (Moore et al, NEJM 2018).

Here is a brief summary:

SOLO-1: patients with BRCA mutation and advanced ovaria...

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