<abstract xmlns="http://www.w3.org/1999/xhtml">

<p>The field of ovarian cancer has been revolutionized with the use of poly (ADP-ribose) polymerase (PARP) inhibitors, which present greater inhibition effect in epithelial subtype due to high rates of homologous recombination deficiency. PARP inhibition exploits this cancer pitfall by disrupting DNA repair, leading to genomic instability and apoptosis. Three PARP inhibitors (olaparib, niraparib, and rucaparib) are now approved for use in women with epithelial ovarian cancer, while others are under development. Among women with <italic>BRCA1/2</italic> mutations, maintenance PARP therapy has led to a nearly fourfold prolongation of PFS, while those without <italic>BRCA1/2</italic> mutations experience an approximately twofold increase in PFS. Differences in trial design, patient selection and primary analysis population affect the conclusions on PARP inhibitors. Limited OS data have been published and there is also limited experience regarding long-term safety. With regard to toxicity profile, there are no differences in serious adverse events between the experimental and control groups. However, combining adverse event data from maintenance phases, a trend towards more events in the experimental group, compared with controls, has been shown. The mechanisms of PARP-inhibitor resistance include restoration of HR through reversion mutations in HR genes, leading to resumed HR function. Other mechanisms that sustain sufficient DNA repair are discussed as well. PARP inhibitors play a pivotal role in the management of ovarian cancer, affecting the future treatment choices. Defining exactly which patients will benefit from them is a challenge and the need for HRD testing to define ‘BRCA-ness’ will add additional costs to treatment.</p>
</abstract>

The field of ovarian cancer has been revolutionized with the use of poly (ADP-ribose) polymerase (PARP) inhibitors, which present greater inhibition effect in epithelial subtype due to high rates of homologous recombination deficiency. PARP inhibition exploits this cancer pitfall by disrupting DNA repair, leading to genomic instability and apoptosis. Three PARP inhibitors (olaparib, niraparib, and rucaparib) are now approved for use in women with epithelial ovarian cancer, while others are under development. Among women with BRCA1/2 mutations, maintenance PARP therapy has led to a nearly fourfold prolongation of PFS, while those without BRCA1/2 mutations experience an approximately twofold increase in PFS. Differences in trial design, patient selection and primary analysis population affect the conclusions on PARP inhibitors. Limited OS data have been published and there is also limited experience regarding long-term safety. With regard to toxicity profile, there are no differences in serious adverse events between the experimental and control groups. However, combining adverse event data from maintenance phases, a trend towards more events in the experimental group, compared with controls, has been shown. The mechanisms of PARP-inhibitor resistance include restoration of HR through reversion mutations in HR genes, leading to resumed HR function. Other mechanisms that sustain sufficient DNA repair are discussed as well. PARP inhibitors play a pivotal role in the management of ovarian cancer, affecting the future treatment choices. Defining exactly which patients will benefit from them is a challenge and the need for HRD testing to define ‘BRCA-ness’ will add additional costs to treatment.

The evolving role of PARP inhibitors in advanced ovarian cancer

Division of Oncology, Department of Internal Medicine

Forum of Clinical Oncology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

{"article-title":"The evolving role of PARP inhibitors in advanced ovarian cancer"}

The field of ovarian cancer has been revolutionized with the use of poly (ADP-ribose) polymerase (PARP) inhibitors, which present greater inhibition effect in...

The evolving role of PARP inhibitors in advanced ovarian cancer

Article Category: Research Article

Publicado en línea: 09 ago 2021

Páginas: 82 - 104

Recibido: 02 ene 2021

Aceptado: 18 feb 2021

DOI: https://doi.org/10.2478/fco-2021-0002

Palabras clave
ovarian cancer, PARP inhibitors, BRCA mutation, maintenance treatment, resistance mechanisms, homologous recombination deficiency

© 2021 Sofia Levva et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

The evolving role of PARP inhibitors in advanced ovarian cancer

Article Category: Research Article

Publicado en línea: 09 ago 2021

Páginas: 82 - 104

Recibido: 02 ene 2021

Aceptado: 18 feb 2021

DOI: https://doi.org/10.2478/fco-2021-0002

Palabras claveovarian cancer, PARP inhibitors, BRCA mutation, maintenance treatment, resistance mechanisms, homologous recombination deficiency

© 2021 Sofia Levva et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Palabras clave
ovarian cancer, PARP inhibitors, BRCA mutation, maintenance treatment, resistance mechanisms, homologous recombination deficiency