Sandro Pignata, MD

FORMAL DISCUSSANT of ARIEL3, Sandro Pignata, MD, of the IRCCS National Cancer Institute, “Fondazione G. Pascale,” Naples, Italy, said: “This is new evidence for maintenance therapy with rucaparib [Rubraca]. These results are extraordinary, particularly in the BRCA mutation patients, but also in the BRCA wild-type and high–loss of heterogeneity subgroups. But rucaparib was also effective even if we consider the whole population.” 

“In an exploratory analysis based on positivity of the homologous recombination deficiency test, even in patients with loss of heterogeneity, there is a significant effect of rucaparib. This means the loss of heterogeneity test cannot identify patients who do not benefit from rucuparib,” he continued. 

With several poly (ADP-ribose) polymerase (PARP) inhibitors now available, including niraparib (Zejula) and olaparib (Lynparza), Dr. Pignata emphasized there are no data to support the superiority of one over another. 

There are some differences in toxicity among PARP inhibitors, he continued, including “small” differences in fatigue, nausea, and anemia. “Thrombocytopenia is more frequent than typical with niraparib, and liver toxicity is more frequent than typical with rucaparib,” he added. 

“We know about these side effects from clinical trials. We don’t know what happens in clinical practice. We need to collect real-life data and learn how to treat the side effects with continued PARP inhibitor therapy. A lot of patients will start maintenance therapy with residual toxicity from chemotherapy. I am not sure we have explored the proper way to use it,” he told the audience. ■ 

DISCLOSURE: Dr. Pignata has received honoraria from AstraZeneca and Tesaro.