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Review
. 2018 Apr;81(4):647-658.
doi: 10.1007/s00280-018-3532-9. Epub 2018 Feb 20.

PARP inhibitors in platinum-sensitive high-grade serous ovarian cancer

Robert D Morgan  1   2 , Andrew R Clamp  1   2 , D Gareth R Evans  3 , Richard J Edmondson  4   5 , Gordon C Jayson  6   7
Affiliations
Review

PARP inhibitors in platinum-sensitive high-grade serous ovarian cancer

Robert D Morgan et al. Cancer Chemother Pharmacol. 2018 Apr.

Abstract

Purpose: Poly(ADP-ribose) polymerase inhibitors (PARPi) have changed the management of high-grade serous ovarian cancer (HGSOC). The rationale for the development of PARPi was based on the concept of synthetic lethality, in which a cell can survive a deficiency of one gene/gene product, but may die if there is a deficiency in a combination of genes/gene products. In women with BRCA1/2 deficiency within their ovarian cancer tissue, inhibition of PARP imposes an intolerable burden of DNA damage repair deficiency and may induce cell death.

Methods: Clinical trials have evaluated PARPi as single-agent therapeutics and as maintenance treatment following platinum-based chemotherapy for HGSOC. Clinical data suggest the most impressive anti-tumour activity occurs in women with platinum-sensitive ovarian cancer and germline or somatic BRCA1/2 mutations (g/sBRCAmt).

Results: In the maintenance setting, randomised trials have shown that PARPi compared to placebo reduce the hazard ratio for the development of progressive disease to 0.2-0.27 for patients with a g/sBRCAmt; to 0.34-0.38 for patients with putative evidence of DNA damage repair deficiency; and to 0.35-0.45 in an unselected population with HGSOC. Furthermore, phase 1/2 trials have reported single-agent anti-tumour response rates in gBRCAmt of approximately 50% in platinum-sensitive and 25% in platinum-resistant disease.

Conclusion: Here, we discuss the evidence for the use of PARPi as single-agent therapeutics and maintenance treatment in HGSOC and evaluate the genetic assays used in clinical trials so far. We discuss the emerging role of platinum sensitivity as a broad eligibility criteria for the use of PARPi.

Keywords: BRCA mutation; Ovarian cancer; PARP inhibitors; Platinum sensitivity.

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Conflict of interest statement

Conflict of interest

Dr. Robert D. Morgan is supported by a research grant from AstraZeneca and The Christie NHS Foundation Trust. Prof. Gordon C. Jayson and Dr. Andrew R. Clamp have received research grants from AstraZeneca. Prof. D. Gareth R. Evans has received travel grants from AstraZeneca and Amgen. Prof. Richard J Edmondson declares that he has no conflict of interest.

Human and animal statement

This article does not contain any studies with human participants or animals performed by any of the authors.

References

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    1. Ledermann JA. PARP inhibitors in ovarian cancer. Ann Oncol. 2016;27(Suppl 1):i40-i44. doi: 10.1093/annonc/mdw094. - DOI - PubMed

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