PARP Inhibitor Treatment for Ovarian Cancer During the COVID-19 Pandemic

Follow-up visits with a provider can be done via video-conferencing calls to monitor side-effects and discuss dose adjustments, though patients still need to get their blood drawn so their doctor can monitor any side effects or toxicities.

"Incorporating PARP inhibitors during the COVID-19 pandemic is an opportunity, because it might mean someone doesn't have to come into an infusion center to get their medication," says Dr. Ramez Eskander, gynecologic oncologist at University of California, San Diego. "I personally haven't had to transition a patient off of one treatment onto a PARP specifically to avoid them coming into the infusion center. I’ve had conversations with patients about … maintenance therapy in the context of COVID-19. I think a lot of this is very regional and institution dependent."

Dr. Eskander says that San Diego has experienced "a relatively low impact from the virus" so most doctors have been able to continue treatments as usual. But some doctors in areas with higher levels of COVID infection have urged patients go for lab work closer to their homes and do regular check-ins by telemedicine rather than office visits both ways to help patients avoid possible contact with the virus.

And because of recent FDA approvals making PARP inhibitors available to more women at more stages of treatment, “If a patient is an appropriate candidate and elects to initiate treatment or transition, providers have been able to offer this to them. It's a beneficial situation," says Dr. Eskander.

More Ovarian Cancer Patients Are Eligible for PARP Inhibitors

Initially PARP inhibitors were recommended for women with a BRCA mutation (a genetic mutation that indicates a woman is at greater risk of developing breast or ovarian cancer), as studies have shown these patients respond especially well to the drugs after recurrence.

However newer research has shown that women with the BRCA gene mutation (and indeed almost all women), can consider using PARP inhibitors throughout their treatment. The Food and Drug Administration has now approved niraparib (brand name ZEJULA) for almost all women with ovarian cancer, regardless of whether or not they have the BRCA mutation, as part of an initial course of treatment.

The PARP inhibitor Lynparza (olaparib) is approved for women newly diagnosed with ovarian cancer and with a germline or somatic mutation in BRCA1/2. Lynparza is also approved in combination with Avastin (bevacizumab) for women with HRD. Avastin is a blood vessel growth inhibitor, which works by starving the tumor of vital nutrients needed to grow.

The American Society of Clinical Oncology (ASCO)  guidelines recommend PARP inhibitors be offered to women, with or without genetic mutations, who are newly diagnosed with stage III or IV ovarian cancer and have improved with chemotherapy.

Unfortunately, too often, ovarian cancer comes back.

For women with ovarian cancer who have had a recurrence and responded to platinum-based chemotherapy, Lynparza, Zejula and another PARP inhibitor called Rubraca (rucaparib) are FDA approved for use as a maintenance therapy, regardless of whether a woman has a BRCA mutation or HRD.

For some women who have had prior chemotherapy treatments, Rubraca, Zejula or Lynparza may also be options. These uses are based on factors such as number of prior therapies and BRCA mutation or HRD.

PARP Inhibitors Are Not Risk-Free

PARP inhibitors can cause serious side effects, and these are especially important to consider in the era of COVID-19.

"The important thing for patients to understand is that PARP inhibitors can initially cause immunosuppression," one oncologist warns. “This primary immunosuppression can put patients at a greater risk of infection because PARP inhibitors are affecting their blood counts."

Immunosuppression is less of a risk for patients who’ve been on PARP inhibitors for a longer period of time since their blood counts usually start to stabilize. However, they still need to exercise caution to prevent infections by diseases like COVID-19.

PARP Patients Still Need Blood Draws

Though cancer patients are being kept away from medical settings as much as possible, those on a PARP inhibitor still need to get regular labs drawn, especially in the early phase of treatment, when blood counts must be monitored more frequently.

Afterward, their provider can set up a telemedicine meeting to go over the results, avoiding another in-person office visit, but allowing them to safely monitor patients and adjust treatments if necessary.

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