How safe is rucaparib in ovarian cancer?

Introduction: Rucaparib is increasingly being utilized for women with recurrent ovarian cancer both as treatment and maintenance therapy. Poly-ADP ribose polymerase (PARP) inhibitors like rucaparib are daily oral medication that exploit the DNA repair pathway. The most significant clinical benefit is in those tumors exhibiting deficiency in their homologous recombination pathway. Areas covered: This review will discuss the mechanism of action, clinical efficacy data, and safety of rucaparib as presented from phase 1, 2, and 3 clinical trials. Expert opinion: Rucaparib is a promising therapeutic option for women where prolongation of survival with favorable side effects is the goal. The side effect profile of rucaparib is similar or more favorable when evaluating it against other PARP inhibitors. Physicians will likely need to have increasing comfort with unique side effects like transaminitis and serum creatinine increases. Clinicians should be prepared for not only increasing utilization of PARP inhibitors in the recurrent setting but also upfront usage may be on the horizon. As >50% of high grade serous ovarian cancers likely have the predictive biomarker, HRD, for PARP inhibition a substantial group of patients stand to have PARP inhibitors as part of their oncologic care.