How long would you continue second line maintenance PARP inhibitor in a patient with recurrent stage IV BRCA+ ovarian cancer who had CR and remains NED?
For patients with platinum-sensitive relapsed ovarian cancer with a partial or complete response to platinum-based chemotherapy, niraparib, olaparib, and rucaparib are approved by the FDA for maintenance therapy. While PFS outcomes are improved with these agents regardless of BRCA mutation status, t...
Difficult to say since the tails of the PFS curves in these second-line maintenance trials were pretty unstable in the analyses. In addition, the number of patients “at risk” in the tails of these trial curves is a very small proportion of those randomized. Overall, each of the trials reported that ...
Generally, until disease progression or unacceptable toxicity. Typically, second (or any subsequent) PFS is much shorter than first PFS, thus it is less likely to continue on PARP-I maintenance for years in this scenario.
In patients with platinum sensitive, BRCA+, recurrent ovarian cancer who have had a CR and remain NED, I favor limiting the duration of PARP maintenance therapy to two years. These patients were included in NOVA (niraparib), SOLO2, Study 19 (olaparib), and ARIEL3 (rucaparib) trials. Patients with ge...
Indefinitely.