by Dr. C.H. Weaver M.D. 10/25/2018
Two-year maintenance therapy with the PARP (poly ADP ribose polymerase) inhibitor Lynparza (olaparib) significantly delays time to cancer progression and prolongs survival when used as part of the initial treatment strategy for advanced ovarian cancer in women with a BRCA 1 or 2 mutation. The results were presented at the European Society of Medical Oncology 2018 annual meeting and published in the prestigious New England Journal of Medicine.
Lynparza is a poly (ADP-ribose) polymerase (PARP) inhibitor indicated for the treatment of selected patients with ovarian, fallopian tube, or primary peritoneal cancer. The PARP enzyme plays a role in DNA repair, including the repair of DNA damage from chemotherapy. Precision cancer medicines that target and inhibit this enzyme may contribute to cancer cell death and increased sensitivity to chemotherapy and are called PARP inhibitors. By blocking this enzyme, DNA inside the cancerous cells is less likely to be repaired, leading to cell death and possibly a slow-down or stoppage of tumor growth.
In the “SOLO-1” clinical trial women with newly diagnosed BRCA positive advanced ovarian cancer were treated with either Lynparza 300 mg twice daily or a placebo for 2 years or until their cancer progressed, which ever came first. Patients with no evidence of disease at 2 years stopped treatment, while those with a partial response could continue treatment.
Overall the therapy was well tolerated, patients treated with Lynparz did not experience a change in health-related quality of life scores while on treatment. Importantly 60% of Lynparza treated patients survived without cancer progression 3 years from the initiation of treatment compared to only 27% of those treated without the maintenance therapy.
Although it’s too early to know for certain the study authors believe that Lynparza maintenance when used as part of initial may actually lead to the cure of additional patients improving the overall outlook for ovarian cancer treatment. It also shifts how physicians must think about ovarian cancer treatment; genetic testing for BRCA will need to be done much earlier as part of the initial treatment evaluation.
What is the best maintenance therapy?
Standard first-line therapy in many countries includes chemotherapy plus Avastin (bevacizumab) maintenance but the question remains whether maintenance with Lynparza alone or in combination with Avastin could be preferable. This question is being addressed by the PAOLA 1 trial, results are expected in 2019.