by NCI Staff
“In the past, we had to choose between olaparib for The VELIA trial took a slightly different approach, testing veliparib as part of first-line treatment and as maintenance therapy.
In three trials, different PARP inhibitors were tested as initial treatment for women with advanced ovarian cancer.Drugs known as PARP inhibitors are used to treat some women with advanced ovarian cancer that has returned after earlier treatment. It will appear on JCO website online but not in the print version. (Type: evidence based, benefits outweigh harms; Evidence quality: high; Strength of recommendation: strong).The addition of olaparib to bevacizumab maintenance may be offered to patients who have stage III-IV, high-grade serous or endometrioid ovarian cancer and germline or somatic pathogenic or likely pathogenic variants in Inclusion of the PARPi veliparib with combination chemotherapy followed by veliparib maintenance therapy cannot be recommended at this time.
[6] If a dose of a PARP inhibitor is missed or vomited, an additional dose should not be taken.Consultation with a nutritionist may be beneficial for management of gastrointestinal side effects. In addition, women are living longer and thus having more overall treatment exposures, which may contribute to accumulated injury. [7] Patients should monitor their blood pressure at home, especially during the first month of treatment, and a plan should be made to initiate/adjust antihypertensives if needed. It was rated as high quality, and it was agreed it would be useful in practice. Alexandra Leary explains the rationale, reviews the trial evidence and clinical experience, and looks to their future possible use in subsets of ovarian cancers without the BRCA germline mutation.
Refinement of testing for patient selection and identification of regimens to treat populations that appear to benefit less from PARP inhibitors are a …
(Type: informal consensus, benefits outweigh harms; Evidence quality: insufficient; Strength of recommendation: moderate).Thrombocytopenia is most common with niraparib.
The The Clinical Practice Guidelines and other guidance published herein are provided by the American Society of Clinical Oncology, Inc. (ASCO) to assist providers in clinical decision making. Niraparib dosing guidelines should be used to lower starting dose (200 mg) based on weight and platelet count.Discontinue PARPi for persistent thrombocytopenia or significant bleeding despite dose reduction. (If only one DNA repair mechanism is defective, then the cell can remain viable.) Background: PARP inhibitors appear to offer a promising role in the accompaniment of many of the cytotoxic agents used in the present day to combat cancer proliferation in BRCA ½ deficient tumors.
A referral to a gastroenterologist for possible endoscopy should be considered if symptoms persist despite dose interruption and use of supportive medications. In the olaparib group, 20% of patients discontinued the treatment due to toxicity.That the combination of bevacizumab and olaparib improves outcomes is an exciting finding, Dr. Annunziata said. In any patient who meets Hy’s criteria for drug-induced liver injury (ie, alanine aminotransferase or aspartate aminotransferase > 3× the upper limit of normal [ULN] with concomitant bilirubin > 2× ULN, without alkaline phosphatase elevations or another clear reason for the elevations), immediate discontinuation of the drug is warranted. What are the biomarker subsets for which PARPis are recommended?3. Specific comments were reviewed by the Expert Panel and integrated into the final manuscript before submission to ASCO guidelines are developed for implementation across health settings. (Type: evidence based, benefits outweigh harms; Evidence quality: high; Strength of recommendation: strong)Treatment with a PARPi should be offered to patients with recurrent EOC who have not already received a PARPi and have a germline or somatic pathogenic or likely pathogenic variants in Options include: olaparib 300 mg every 12 hours; rucaparib 600 mg every 12 hours; niraparib 200-300 mg once daily. PARP inhibitors are another tool to battle recurrent ovarian cancer and may extend survival rates by months, but ovarian cancer remains a deadly disease.