Dr Chambers on Access, Toxicities, and Long-term Considerations for PARP Inhibitors in Ovarian Cancer

Laura J. Chambers, DO, assistant professor, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center—James, addresses the challenges patients with ovarian cancer face in accessing PARP inhibitors, emphasizing the need for careful patient evaluation and management.

Chambers explains that although PARP inhibitors are valuable in the treatment and maintenance of ovarian cancer, financial toxicity remains a significant barrier to patient access. Despite FDA-approved indications, many patients encounter high out-of-pocket costs due to inadequate insurance coverage, she says. This financial burden, coupled with the existing challenges of ongoing cancer treatment, can complicate access to these therapies for some patients, she notes.

In addition to financial toxicity, Chambers discusses the management of common adverse effects (AEs) associated with PARP inhibitors, including hematologic toxicities such as thrombocytopenia and anemia, as well as gastrointestinal AEs and fatigue. Although these toxicities are typically manageable, maintaining a good quality of life for patients during prolonged maintenance therapy is critical, Chambers explains.

Moreover, Chambers expresses concerns about the impact PARP inhibitors may have on subsequent treatment efficacy, specifically highlighting the potential for these agents to induce resistance to platinum-based chemotherapy—the cornerstone of ovarian cancer treatment. She underscores that emerging data from trials such as the phase 3 OReO/ENGOT Ov-38 trial (NCT03106987) suggest that PARP inhibitors could make tumors more resistant to platinum-based chemotherapy, thus complicating future treatment decisions and affecting overall outcomes.

Chambers advises that careful patient selection and ongoing assessment are essential to optimize the benefits of PARP inhibitors without exposing patients to unnecessary AEs if they may not benefit from the treatment. Transparent discussions between clinicians and patients regarding the expected benefits, potential toxicities, and financial implications of PARP maintenance therapy are crucial, she says. By setting realistic expectations, oncologists can help patients make informed decisions that align with their treatment goals and individual circumstances, Chambers concludes.