Rucaparib Beneficial as Maintenance Treatment for Recurrent Ovarian Cancer

Highlights:

• Cancer of the ovaries is often detected at a late stage.
• Patients with BRCA mutations are at a high risk for ovarian cancer
• Rucaparib has been found to benefit patients with recurrent, platinum-sensitive ovarian cancers when used as maintenance treatment

Rucaparib has been found to be effective in delaying recurrence of ovarian cancer in women with BRCA mutations, as demonstrated in the ARIEL3 study. The results of the study were presented at the ESMO 2017, the Annual Congress of the European Society for Medical Oncology in Madrid, Spain. Ovarian cancer usually affects postmenopausal women who also often suffer from breast cancer. The presence of mutations in the BRCA1 and BRCA2 genes, which are tumor suppressive genes, increase the risk of both breast and ovarian cancer. Women with a family history are at a high risk. Symptoms of ovarian cancer like pain and pressure in the pelvic region usually appear late. Therefore, most patients present at a late stage, when the cancer has already spread and a complete cure is difficult. Various options are available, which include surgery, chemotherapy, hormone therapy, targeted therapy and radiation therapy or a combination of two or more of these treatments. Women who respond to treatment are put on maintenance treatment to prevent recurrences, which are extremely common in these patients.

Rucaparib is a drug that received accelerated approval by the US Food and Drug Administration for the treatment of advanced ovarian cancer in women who have the BRCA mutation and have received two or more chemotherapies. Rucaparib acts as a PARP (poly (ADP-ribose) polymerase) inhibitor. It prevents repair of DNA and kills cancer cells.

The ARIEL3 clinical trial is a Phase 3 study that evaluated the efficacy of rucaparib in recurrent, high-grade ovarian, fallopian tube, or primary peritoneal cancer when given as maintenance treatment following platinum-based therapy (Platinum-based chemotherapy includes drugs like cisplatin and carboplatin). The women included in the study had a complete or partial response to treatment with 2 or more platinum-based therapies

Out of the 564 women included in the study, 375 women received 600 mg of rucaparib twice daily while another 189 women were administered a placebo for comparison. On examining the data, the researchers found that:

• The progression-free survival significantly improved in the patients taking rucaparib in women with BRCA mutations. It improved by 77% in this group

• Women who did not have the BRCA mutation also benefitted, though to a lesser extent.

• The most common adverse effects included anemia and increase in liver enzymes. 13.4% women on rucaparib and 1.6% of rucaparib on placebo discontinued treatment due to the adverse effects. Deaths due to adverse effects, which included disease progression, were 1.6% in the rucaparib group and 1.1% in the placebo group.

Thus, since rucaparib improved progression-free survival, it is likely to be beneficial as maintenance treatment in women with recurrent, platinum-sensitive ovarian cancer, especially with BRCA mutation.

Reference:

1. Ledermann J, et al. ARIEL3: A Phase 3, Randomised, Double-Blind Study of Rucaparib vs Placebo Following Response to Platinum-Based Chemotherapy for Recurrent Ovarian Carcinoma (OC). Presented on Friday, 8 September 2017 at ESMO 2017 Congress
2. Ovarian, Fallopian Tube, and Primary Peritoneal Cancer Prevention (PDQ®)–Health Professional Version - (https://www.cancer.gov/types/ovarian/hp/ovarian-prevention-pdq)

Source-Medindia