Treating ovarian cancer patients with PARP inhibitors

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Published: 8 May 2019
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Kimberly Halla - Arizona Oncology Associates PC, Scottsdale, USA

Kimberly Halla speaks to ecancer at ONS 2019 about the role of PARP inhibitors in the ovarian cancer world.

She explains about the role of germline testing and somatic testing in determining treatment options for ovarian cancer patients, as well as highlighting some of the clinical trials in progress.

Kimberly explains that PARP inhibitors are providing ovarian cancer patients with longer progression free survival and are empowering patients by allowing them to take the oral therapy at home, giving them more time with their friends and family.

We talked about the role of PARP inhibitors in the ovarian cancer world and how PARP inhibitors are new to the game of ovarian cancer and it’s allowing women to have a longer time of progression free survival, so time in between treatments. Ovarian cancer patients, about 85% of them are going to reoccur so we talk about how PARP inhibitors can lengthen that time between treatments.

What is the role of companion diagnostics with regards to PARP inhibitors?

The PARP inhibitors have different roles in how they are used, so those who are germline tested and somatic testing are a little bit different. Every ovarian cancer patient, whether they are ovarian cancer, fallopian tube, primary peritoneal, all should have germline testing.  Those PARP inhibitors that require that, such as rucaparib, in their treatment settings would need to know if they are BRCA positive or if they are BRCA negative. That also will then lead to somatic testing, so somatic testing is actually testing the tumour itself. The difference between them would be that the germline is what we inherited from our parents and that we can pass down to our offspring. The somatic change in the tumour itself is not inherited and it cannot be passed on. So some of the PARP inhibitors require a genetic marker and others do not.

Are there any challenges that oncology nurses face with these treatments?

Absolutely, with new treatment there are always challenges and we need to know the side effects and we need to know them well. We need to have the patients who call in understand and I think that is helpful when you set some realistic boundaries and some realistic guidelines with your patients. We need to know what anaemia is; we need to know what’s causing their anaemia; we need to know how tired they are. If the nursing can play a role in that our ultimate goal is to keep patients on medication. So if we can fix the small problems and keep our patients on medication that’s going to be the best outcome for everybody.

How do you see PARP inhibitors being used in the future?

We have multiple indications for our PARP inhibitors but ongoing research is telling us do they work better with, say, different medications? Do they work better with an immune medication? Do they work better with bevacizumab? Some of the ongoing treatments will tell us that and the ongoing clinical trials will tell us that. We’re also wrapping up a few of our clinical treatments – the JAVELIN 100 PARP will give us some great information that tells us doing PARP with active chemotherapy, is that better or is doing PARP after chemotherapy, is that better? So learning where PARP inhibitors and finding their sequence is our next goal.

How do they compare to other treatments?

In traditional settings patients are in an infusion suite and they are either there weekly or they are there every three weeks. A lot of lab abnormalities, a lot of lab assessments, compared to PARP inhibitors which is a medication, depending on the PARP inhibitor that you choose, you can take twice a day or just once a day depending on how your clinician prescribes it. Traditionally we have time because ovarian cancer patients reoccur and what we ultimately want is quality time with family and friends. So the ability to take a pill at home rather than coming into an office or a clinic or a hospital setting, that, to me, is wonderful. Giving patients time with their family and friends is exactly what we want to do and oral therapy is very, very new to the ovarian cancer world so educating not only nurses but clinicians and patients because patients are hearing these advertised on television, their friends and their group chats and they want to know how come I can’t be on this medication. So education for not only patients but also for the nursing staff as well helps.

What is your take home message for oncology nurses?

The take home message is listen to your patients. Our patients want to be on these medications, they want to live. The ability to offer them maintenance without being in our infusion rooms or in our offices and allowing them to continue to live their life, not only be alive but to live their life, is one of the greatest gifts we can really offer them.