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PARP Inhibitors in the Management of Ovarian Cancer

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Key Points ➤ These recommendations pertain only to patients with epithelial ovarian, tubal, or primary peritoneal cancer who have not previously received a poly(ADP-ribose) polymerase inhibitors (PARPi). ➤ The recommendations are based on clinical trial results and FDA approvals and do not necessarily capture regulatory approvals in other jurisdictions. Repeating PARPi ➤ Repeating PARPi therapy in the treatment of epithelial ovarian cancer (EOC) is NOT recommended at this time. Consideration should be made as to the best time in the life cycle of an individual patient's EOC in which to use PARPi. Clinical trial participation is encouraged. (Strong recommendation; IC-B-Ins) Newly diagnosed ovarian cancer ➤ PARPi are NOT recommended for use in initial treatment of early stage (stage I-II) EOC, since there is insufficient evidence to support use in this population. (Strong recommendation; IC-B-Ins) ➤ Women with newly diagnosed stage III-IV EOC who are in complete or partial response to first-line platinum-based chemotherapy should be offered PARPi maintenance therapy with olaparib (for those with germline or somatic pathogenic or likely pathogenic variants in BRCA1 or BRCA2 genes) or niraparib (all women) in high grade serous or endometrioid ovarian cancer. (Strong recommendation; EB-B-H) • PARPi maintenance therapy should consist of olaparib (300 mg PO every 12 hours for two years) or niraparib (200–300 mg PO daily for three years). Longer duration could be considered in selected individuals. ➤ The addition of olaparib to bevacizumab maintenance may be offered to patients who have stage III-IV high grade serous or endometrioid ovarian cancer and germline or somatic pathogenic or likely pathogenic variants in BRCA1 or BRCA2 genes and/or genomic instability, as determined by Myriad myChoice ® CDx, and who have had a partial or complete response to chemotherapy + bevacizumab combination. (Strong recommendation; EB-B-H) Treatment

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