View all CPC CME

Share a PER® activity with your colleagues or friends. Connect with the PER® social network.



Accreditation/ Credit Designation

Physicians’ Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. These activites are not approved for AMA PRA Category 1 Credit

Acknowledgment of Commercial Support

This activity is supported by educational grants from Clovis Oncology, Inc. and Myriad Genetics, Inc.


Community Practice Connections™: Redefining Ovarian Cancer Treatment Paradigms by Maximizing Therapeutic Outcomes With PARP Inhibitors PER Pulse™ Recap

PER Pulse Recap

PER Pulse™ Recap


1 of 3
PER Pulse™ Recap

Current Treatment Standards for Advanced Ovarian Cancer

Community Practice Connections™: Redefining Ovarian Cancer Treatment Paradigms by Maximizing Therapeutic Outcomes With PARP Inhibitors features a review of key data and evolving treatment paradigms highlighted at the live satellite symposium held at the 2017 American Society of Clinical Oncology annual conference. Interviews with distinguished ovarian cancer experts, including Robert L. Coleman, MD, FACOG, FACS; Deborah K. Armstrong, MD; Michael Birrer, MD; and Maurie Markman, MD, provide perspective on the clinical implications and patient management applications of emerging evidence and state-of-the-art approaches to the treatment of patients with advanced ovarian cancer. This first of 3 PER Pulse™ Recaps focuses on current treatment standards for advanced ovarian cancer.

  • Primary surgical management with the goal of maximal cytoreduction, followed by platinum-based combination chemotherapy, remains the standard of care for newly diagnosed ovarian cancer. Neoadjuvant chemotherapy may also be used.
  • A regimen incorporating a platinum agent and a taxane, administered for 6 to 8 cycles, is considered the standard for systemic therapy. Including bevacizumab, the anti-angiogenic agent, as part of the induction regimen and as a monotherapy for maintenance is supported by the improvement in progression-free survival observed in the phase III GOG 0218 and ICON7 trials.
  • For patients with recurrent, platinum-sensitive disease, treatment is typically an alternate platinum-based regimen, with or without bevacizumab. For platinum-resistant disease, options include single-agent therapy with a nonplatinum cytotoxic agent, such as docetaxel, etoposide, gemcitabine, liposomal doxorubicin, weekly paclitaxel, or topotecan. Bevacizumab and pazopanib have also demonstrated activity when added to chemotherapy in recurrent and refractory ovarian cancer.

For additional commentary about this topic and others, please visit www.gotoper.com.


2 of 3
PER Pulse™ Recap

PARP Inhibitors: Rationale, Current Evidence, and Future Directions

Community Practice Connections™: Redefining Ovarian Cancer Treatment Paradigms by Maximizing Therapeutic Outcomes With PARP Inhibitors features a review of key data and evolving treatment paradigms highlighted at the live satellite symposium held at the 2017 American Society of Clinical Oncology annual conference. Interviews with distinguished ovarian cancer experts, including Robert L. Coleman, MD, FACOG, FACS; Deborah K. Armstrong, MD; Michael Birrer, MD; and Maurie Markman, MD, provide perspective on the clinical implications and patient management applications of emerging evidence and state-of-the-art approaches to the treatment of patients with advanced ovarian cancer. This second of 3 PER Pulse™ Recaps focuses on the rationale for the use of poly (ADP-ribose) polymerase (PARP) inhibitors for advanced ovarian cancer, current evidence and indications, and future directions for investigation.

  • PARP inhibitors block the base excision single-strand DNA repair process, leading to the accumulation of double-strand breaks. In cells with an intact homologous recombination repair pathway, which targets double-strand breaks, PARP inhibition is nonlethal. However, in cells with a homologous recombination deficiency (HRD), inhibition of PARP causes catastrophic DNA damage, resulting in cell death. This concept known as synthetic lethality.
  • Mutation and silencing of the BRCA1/2 genes are the most common mechanisms that lead to HRD, but dysregulation of other genes involved in the double-strand DNA repair process may also confer sensitivity to PARP inhibitors. Several molecular assays have been developed to identify BRCA1/2 wild-type cancers that also demonstrate HRD.
  • Three PARP inhibitors have now received approval from the US Food and Drug Administration for use in advanced ovarian cancer.
    • Olaparib received accelerated approval for germline BRCA1/2-mutated advanced ovarian cancer previously treated with ≥3 lines of chemotherapy, based on results of a phase II trial demonstrating a 34% response rate and 40% stable disease rate in patients with platinum-resistant disease. More recently, the indication was expanded to include its use as a single-agent maintenance therapy for patients responding to a platinum-based regimen based on the significant extension of progression-free survival (PFS) observed in the phase III SOLO-2 trial.
    • Rucaparib received accelerated approval for the treatment of advanced ovarian cancer with either a germline or somatic BRCA mutation following ≥2 prior chemotherapies. Approval was based on the activity observed in the subgroup of patients with BRCA-mutant, recurrent, platinum-sensitive, high-grade ovarian cancers in the phase II ARIEL-2 study.
    • Niraparib is indicated for the maintenance treatment of adult patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in complete or partial response to platinum-based chemotherapy. Approval was based on results from the phase III NOVA trial in patients with platinum-sensitive, recurrent, high-grade serous ovarian cancer, which demonstrated a significant improvement in median PFS with niraparib maintenance therapy compared with placebo.
  • Future directions include investigating PARP inhibitors in the upfront setting for newly diagnosed ovarian cancer. PARP inhibitors are also being evaluated in combination with other targeted agents, such as anti-angiogenic agents and immune checkpoint inhibitors.

For additional commentary about this topic and others, please visit www.gotoper.com.


3 of 3
PER Pulse™ Recap

Managing PARP Inhibitor-Associated Toxicities

Community Practice Connections™: Redefining Ovarian Cancer Treatment Paradigms by Maximizing Therapeutic Outcomes With PARP Inhibitors features a review of key data and evolving treatment paradigms highlighted at the live satellite symposium held at the 2017 American Society of Clinical Oncology annual conference. Interviews with distinguished ovarian cancer experts, including Robert L. Coleman, MD, FACOG, FACS; Deborah K. Armstrong, MD; Michael Birrer, MD; and Maurie Markman, MD, provide perspective on the clinical implications and patient management applications of emerging evidence and state-of-the-art approaches to the treatment of patients with advanced ovarian cancer. This third of 3 PER Pulse™ Recaps focuses on the management of side effects associated with the use of poly (ADP-ribose) polymerase (PARP) inhibitors for the treatment of advanced ovarian cancer.

For additional commentary about this topic and others, please visit www.gotoper.com.

  • PARP inhibitors are generally well tolerated, even in heavily pretreated patients, and grade 4 adverse events are rare.
  • The most common hematologic toxicities associated with the available PARP inhibitors are anemia, thrombocytopenia, and neutropenia. Regular monitoring of blood counts is necessary and transfusions may be used as needed.
  • Gastrointestinal adverse events, such as nausea, vomiting, diarrhea, and constipation also appear to be a class effect. Antiemetics, antidiarrheals, and laxatives can be useful in preventing and managing these toxicities.
  • One rare but serious potential side effect that appears to be associated with all of the available PARP inhibitors is the increased risk of development of myelodysplastic syndrome or acute myelogenous leukemia, with rates of 1.1% to 1.4% observed in clinical trials to date. If hematologic toxicities do not resolve promptly (within 4 weeks) after discontinuation of PARP inhibitor therapy, a hematologic work-up should be performed.




Calendar of Events
SUNMONTUESWEDTHURSFRISAT
   1234
567891011
12131415161718
19202122232425
2627282930
Filter By