Whitney Goldsberry, MD, clinician at the University of Alabama at Birmingham Hospital and fellow at the UAB Division of Gynecologic Oncology, gives her insight into the future of PARP inhibitors in ovarian cancer treatment.
Whitney Goldsberry, MD, clinician at the University of Alabama at Birmingham Hospital and fellow at the UAB Division of Gynecologic Oncology, gives her insight on the future of PARP inhibitors in ovarian cancer treatment.
One issue with PARP inhibitors is the likelihood of acquired or initial resistance. What current or potential clinical strategies can mitigate this resistance?
This is definitely a concern we have as we're moving forward in ovarian cancer treatment in the future. What we've found from current data is that patients who are most likely to benefit from PARP inhibitors are those with a pathogenic BRCA mutation or other homologous recombination deficiencies. We do know that the BRCA reversion is a possibility that can make these patients actually less susceptible to the benefits of PARP inhibitors. As we move forward, it will be important to figure out other ways to actually overcome PARP inhibitor resistance with these different reversions.
What do you see on the horizon for PARP inhibitors in ovarian cancer treatment, whether in novel therapies/combinations or in regulatory changes?
I think the next steps in PARP inhibitor development include identifying additional biomarkers that may indicate which patients will benefit the most from this class of therapies. There are currently several clinical trials looking into combining PARP inhibitors with other types of therapies, such as immunotherapy or other anti-angiogenics to see if there's a synergistic effect with these combinations. It'll also be interesting to see the efficacy of PARP inhibitors used after prior PARP inhibitor use. And inevitably, there'll be more information on this topic as we start to increase PARP inhibitor use in frontline treatments.
Any final thoughts?
PARP inhibitors are so amazing in ovarian cancer, because we haven't had anything like this in 20 years that's actually been able to almost “cure” some types of ovarian cancers—like if a patient has a platinum response and then she gets put on a PARP inhibitor with these BRCA mutations. They're on it for like 2 years, and then some of them don't recur. And that's unheard of in our field before, so it's a very exciting time for us.