The American Society of Clinical Oncology (ASCO) has updated its guidelines for the use of PARP inhibitors in patients with advanced epithelial ovarian cancer.
The update, which includes new recommendations for patients with newly diagnosed and recurrent disease, was prompted by data from phase 3 trials showing positive and negative results with PARP inhibitors.
The update was recently published in the Journal of Clinical Oncology.
Newly Diagnosed Patients
The updated guidelines recommend PARP inhibitor maintenance for patients with newly diagnosed, stage III-IV, high-grade serous or endometrioid ovarian cancer who responded to first-line platinum-based chemotherapy.
Olaparib (300 mg orally every 12 hours for 2 years), rucaparib (600 mg twice a day for 2 years), and niraparib (200-300 mg orally daily for 3 years) are options for patients with germline or somatic pathogenic or likely pathogenic variants in BRCA1/2. Treatment may be extended in certain patients.
Rucaparib and niraparib are options for patients who are homologous recombination deficiency (HRD)-positive or those who are HRD-negative and do not have BRCA mutations.
Patients With Recurrent Disease
The guidelines state that second-line or later maintenance with a PARP inhibitor is an option for patients with recurrent epithelial ovarian cancer who have not already received a PARP inhibitor and who responded to platinum-based therapy, regardless of BRCA mutation status.
Olaparib (300 mg every 12 hours), rucaparib (600 mg every 12 hours), or niraparib
(200-300 mg once daily) can be given until disease progression or toxicity that persists despite dose reductions and best supportive care.
The guideline authors noted that niraparib maintenance may prolong progression-free survival (PFS) but shorten overall survival (OS) for patients without germline or somatic BRCA mutations. Therefore, clinicians should “weigh the potential PFS benefit against the possible OS decrement.”
The guidelines recommend against routine use of PARP inhibitor monotherapy for patients with recurrent, platinum-sensitive epithelial ovarian cancer.
“Any decision to proceed with PARPi treatment in select populations (BRCA mutation, no prior PARPi use, platinum sensitive, advanced lines of treatment) should be based on individualized patient and provider assessment of risks, benefits, and preferences,” the authors wrote.
The guideline authors also recommend against the use of PARP inhibitor monotherapy for patients with BRCA wild-type or platinum-resistant recurrent epithelial ovarian cancer.
Tew WP, Lachetti C, Kohn EC, et al. Poly(ADP-ribose) polymerase inhibitors in the management of ovarian cancer: ASCO Guideline Rapid Recommendation Update. J Clin Oncol. Published online September 23, 2022. doi:10.1200/JCO.22.01934