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Niraparib for the treatment of ovarian cancer

Yada Kanjanapan1, Stephanie Lheureux1, Amit M Oza1

  • 1a Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre , University of Toronto , Toronto , Canada.

Expert Opinion on Pharmacotherapy
|March 17, 2017
PubMed
Abstract

Insights

Niraparib, a PARP inhibitor, significantly improves progression-free survival in ovarian cancer patients. This maintenance therapy benefits all women, especially those with BRCA mutations or HRD-positive tumors.

Area of Science:

  • Oncology
  • Pharmacology

Background:

  • Poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors are investigated for ovarian cancer maintenance and recurrence treatment.
  • These inhibitors induce synthetic lethality by blocking single-stranded DNA repair in homologous recombination deficiency (HRD) contexts.
  • Ovarian cancers with BRCA1/2 mutations show marked responses, and HRD-positive HGSOC may also benefit.

Purpose of the Study:

  • To review niraparib's clinical testing in ovarian cancer.
  • To discuss the Myriad MyChoice HRD test as a companion diagnostic.
  • To highlight future directions and ongoing trials, including novel combinations.

Main Methods:

  • Focus on niraparib, an oral PARP I and II inhibitor.
  • Clinical testing in ovarian cancer settings.
  • Inclusion of the Myriad MyChoice HRD test.

Main Results:

  • Level 1 evidence from a randomized, placebo-controlled phase III trial of niraparib maintenance in platinum-sensitive recurrent HGSOC.
  • Niraparib improved progression-free survival (PFS) across all patient groups compared to placebo.
  • Greatest PFS benefit observed in patients with germline BRCA1/2 mutations, followed by HRD-positive tumors.

Conclusions:

  • Niraparib maintenance therapy demonstrates efficacy in platinum-sensitive recurrent HGSOC.
  • Benefit is evident across all patient groups, irrespective of BRCA mutation or HRD status, though greatest in specific subgroups.
  • Ongoing studies are evaluating niraparib in first-line maintenance and later recurrence settings.
Keywords:
BRCA1/2 mutationNiraparibhomologous recombination deficiencymaintenanceovarian cancer

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