Treatment
➤ Inclusion of the PARPi, veliparib, with combination chemotherapy
followed by veliparib maintenance therapy cannot be recommended at
this time. There are no data that this approach is superior, equal, or less
toxic than a switch maintenance. (Strong recommendation; EB-B/H ratio
unknown-I)
Note: As of this writing, veliparib is not commercially available.
Recurrent ovarian cancer - Second-line or Greater Maintenance
and Treatment
➤ PARPi monotherapy maintenance (second-line or more) may be offered
to patients with EOC who have not already received a PARPi and
who have responded to platinum-based therapy regardless of BRCA
mutation status. Treatment is continued until progression of disease
or toxicity despite dose reductions and best supportive care. (Strong
recommendation; EB-B-H)
• Options include: olaparib 300 mg every 12 hours; rucaparib 600 mg every 12 hours;
niraparib 200–300 mg once daily.
➤ Treatment with a PARPi should be offered to patients with recurrent EOC
who have not already received a PARPi and have a germline or somatic
pathogenic or likely pathogenic variants in BRCA1 or BRCA2 genes.
(Strong recommendation; EB-B-H)
• Options include: olaparib 300 mg every 12 hours; rucaparib 600 mg every 12 hours;
niraparib 200–300 mg once daily.
➤ Treatment with a PARPi monotherapy should be offered to patients with
recurrent EOC who have not already received a PARPi and whose tumor
demonstrates genomic instability, as determined by Myriad myChoice
®
CDx, and has not recurred within 6 months of platinum-based therapy.
(Strong recommendation; EB-B-H)
➤ PARPi are NOT recommended for treatment of BRCA wild-type or
platinum-resistant recurrent EOC. (Strong recommendation; EB-B-H)
PARPi in Combination
➤ PARPi are NOT recommended for use in combination with chemotherapy,
other targeted agents, or immune-oncology agents in the recurrent
setting outside the context of a clinical trial. Clinical trial participation is
encouraged. (Strong recommendation; IC-B-Ins)
