- Olaparib is indicated for: 1) treatment of recurrent ovarian cancer in patients with germline BRCA mutations after ≥ 3 prior lines of chemotherapy; 2) as post-platinum maintenance therapy for platinum-sensitive recurrences that responded to platinum-based chemotherapy, regardless of BRCA or homologous recombination deficiency (HRD) status.
- Rucaparib is indicated for: treatment of recurrent BRCA-mutated ovarian cancer (either germline or somatic mutation) after ≥ 2 prior lines of chemotherapy.
- Niraparib is indicated for: post-platinum maintenance therapy in patients with platinum-sensitive recurrent ovarian cancer who responded to platinum-based chemotherapy, regardless of BRCA or HRD status. Niraparib must be started within 8 weeks of the last platinum dose.
- All three poly(ADP-ribose) polymerase (PARP) inhibitors cause fatigue, myelosuppression, and gastrointestinal side effects. Toxicity can be mitigated by preemptive patient education, prescription of prophylactic supportive medications, and careful patient selection.
- Niraparib is associated with significant thrombocytopenia, especially in the first 4 to 6 weeks of treatment. Olaparib and rucaparib may cause a rise in the serum creatinine level, thought to be due to their effect on the multidrug and toxin extrusion transporter in the kidney. Rucaparib may cause clinically insignificant transient elevations in liver transaminase levels.