Paul Sabbatini, MD, attending physician at Memorial Sloan-Kettering Cancer Center, New York, said that Study 19 is a well-designed study that showed PARP inhibition is a successful maintenance therapy for serous ovarian cancer that avoids the toxicity associated with continued cytotoxic chemotherapy.
“Most importantly, the study shows that BRCA mutation is a robust biomarker for benefit of olaparib and will be appropriately used to guide phase III studies for this indication. However, this biomarker should not limit all future investigations with PARP inhibitors. For example, in breast cancer, PARP inhibition shows activity independent of BRCA status,” he noted.
Dr. Sabbatini agreed with Dr. Ledermann that it is difficult to show a survival advantage for maintenance olaparib in this setting in patients treated with several subsequent lines of treatment. “Can we attribute an overall survival benefit to one intervention?” he asked.
The timing of maintenance therapy is a crucial issue, Dr. Sabbatini continued. “This study shows the value of starting maintenance therapy after the primary chemotherapy, potentially avoiding the additive toxicity of combining PARP inhibition with paclitaxel and carboplatin.” This issue remains to be clarified by upcoming clinical trials. ■
Disclosure: Dr. Sabbatini reported no potential conflicts of interest.