Commenting on the SOLO2 trial for The ASCO Post was Don S. Dizon, MD, FACP, FASCO, Director of Women’s Cancers at Lifespan Cancer Institute and Professor of Medicine at Brown University, Providence, Rhode Island.
Don S. Dizon, MD, FACP, FASCO
“It’s great to get an overall survival advantage from a PARP inhibitor study. Coming into these results, we had consistently shown that PARP inhibitors improve progression-free survival in advanced ovarian cancer, but we’ve been waiting for the overall survival data,” he said. That said, while support for using PARP inhibitors is greatly boosted by the findings of SOLO2, questions for clinicians remain, Dr. Dizon added.
SOLO1 studied olaparib maintenance in newly diagnosed patients and showed that 60% of the maintenance arm was progression-free at 3 years; survival data are still pending. The SOLO2 population had received at least two prior lines of therapy but were olaparib-naive. All patients had BRCA mutations and had responded to platinum-based chemotherapy.
“The issue is, PARP inhibitors have shown activity in pretty much all the ovarian cancer treatment settings, particularly for BRCA-mutated disease. Importantly, they are used in the front-line setting as well. A lot of oncologists have started to use PARP inhibitors as part of the standard of care in the first line,” he said.
“So what is not yet answered is this: if you use olaparib in the front-line setting and the patient has disease progression, and you treat with platinum and achieve remission, can you use olaparib again as maintenance, based on SOLO2? Can I tell this patient she can expect a survival benefit? Based on the data, I don’t think I can,” he said.
Dr. Dizon added that patients with homologous recombination repair deficiency (HRD)—who include some patients with BRCA wild-type disease—also constitute a population who may respond to PARP inhibition, though not as robustly. He tests for this in his patients and offers patients with HRD-positive disease PARP inhibitors as well.
DISCLOSURE: Dr. Dizon serves on data safety monitoring boards for Clovis Oncology, AstraZeneca, and Regeneron and has institutional support for clinical trials funded by Bristol-Myers Squibb, Tesaro, Kazia Therapeutics, and Lilly.
For the first time, overall survival has been improved with maintenance therapy involving a poly (ADP-ribose) polymerase (PARP) inhibitor in patients with platinum-sensitive recurrent ovarian cancer associated with BRCA1/2 mutations.
In the final, preplanned, overall survival analysis in the...