“I think the NOW trial is a great study,” said Kathleen Moore, MD, MS, the Virginia Kerley Cade Endowed Chair in Cancer Developmental Therapeutics and Professor of Gynecologic Oncology at the University of Oklahoma Health Sciences Center, Oklahoma City, who shared her thoughts on the trial with The ASCO Post. “While we can’t make any definitive statements based on data from a small study, Dr. Westin and colleagues have demonstrated that neoadjuvant olaparib is feasible. And there are certainly patients who are very interested in a nonchemotherapy approach.”
Kathleen Moore, MD, MS
As Dr. Moore pointed out, neoadjuvant therapy (with a plan for interval surgery after several cycles of chemotherapy) is a well-established approach in ovarian cancer. For patients with BRCA mutations, olaparib would be a much less toxic and far more convenient therapy than chemotherapy. “The concept is excellent—the use of a targeted therapy in a biomarker-selected population as early as possible in those settings where it might be curative,” she remarked. “There is a lot of interest in targeted approaches, and patients as well are very interested in having a tailored, individualized treatment regimen based on their tumor and their molecular and genetic makeup.”
After two cycles of olaparib in the NOW trial, 85% of patients who completed two cycles and surgery had no evidence of gross disease. Whether this aligns with the outcomes derived from chemotherapy is hard to say at this point, she added. “Despite a lot of work that’s been done recently, I don’t think we have that granularity. That’s a missing piece, and it’s something we should study,” she said. “But it’s certainly reassuring that in this small number of patients, it’s more than 80%. That’s a good signal.”
DISCLOSURE: Dr. Moore has served in a leadership role with GOG Partners and NRG Ovarian Committee Chair; has received honoraria from Research To Practice, Prime Oncology, Physician Education Resource, and Great Debates and Updates; has served as a consultant or advisor to AADi, Alkemeres, AstraZeneca, Blueprint Pharmaceuticals, Caris Life Sciences, Clovis Oncology, Eisai, Genentech/Roche, GSK/Tesaro, Hengrui Pharmaceutical, IMab, Immunogen, InxMed, Iovance Biotherapeutics, Merck, Mereo BioPharma, Mersana, Myriad Genetics, Novartis, Novartis/Pfizer, Onconova Therapeutics, OncXerna Therapeutics, VBL Therapeutics, and Verastem/Pharmacyclics; has received research funding from Agenus, Amgen, Artios, AstraZeneca, Bolt Biotherapeutics, Bristol Myers Squibb, Clovis Oncology, Cyteir, Daiichi Sankyo/Lilly, Genentech, Immunocore, Immunogen, Eli Lilly, Lilly Foundation, Merck, Novartis Pharmaceuticals UK Ltd., Novogen, PTC Therapeutics, Regeneron, Takeda, Tesaro, and Verastem; has patents, royalties, or other intellectual property with Up to Date; has received travel expenses from AstraZeneca and GSK; and has reported relationships with GOG Partners.
