Maintenance treatment for recurrent ovarian carcinoma – Evidence supporting the efficacy and safety of PARP inhibitors

Abstract

While recent advances in treatment mean that women with ovarian cancer are living longer, many eventually experience disease relapse highlighting the need for new treatments that can extend progression-free survival (PFS). The PARP inhibitors olaparib, niraparib and rucaparib have been approved by the US Food and Drug Administration and the European Commission and are currently available for the maintenance treatment of patients with recurrent epithelial ovarian, fallopian tube or primary peritoneal cancer who are in a complete or partial response to platinum-based chemotherapy. Here, we review the efficacy and safety data from the key clinical trials supporting the approvals for these treatments as second-line maintenance therapies, including Study 19, SOLO2/ ENGOT-OV21 (olaparib), NOVA/ENGOT-OV16 (niraparib) and ARIEL3 (rucaparib). Across trials, PFS was improved with PARP inhibitor maintenance treatment versus placebo in patients with a BRCA mutation. However, evidence from some of the trials shows that a wider group of patients can benefit from PARP inhibitor maintenance treatment including those with or without homologous recombination deficient tumours. The safety profile for olaparib, niraparib and rucaparib was generally similar across trials with haematological and gastrointestinal adverse events and fatigue/asthenia being the most common. As evidenced by the significant improvements in PFS and manageable safety profiles in these trials, PARP inhibitors represent a new standard of care for recurrent ovarian cancer following platinum-based chemotherapy and delay the need for further chemotherapy.