FDA Approval Summary: Olaparib Monotherapy in Patients with Deleterious Germline BRCA-Mutated Advanced Ovarian Cancer Treated with Three or More Lines of Chemotherapy

On December 19, 2014, the FDA approved olaparib capsules (Lynparza; AstraZeneca) for the treatment of patients with deleterious or suspected deleterious germline BRCA-mutated (gBRCAm) advanced ovarian cancer who have been treated with three or more prior lines of chemotherapy. The BRACAnalysis CDx (Myriad Genetic Laboratories, Inc.) was approved concurrently. An international multicenter, single-arm trial enrolled 137 patients with measurable gBRCAm-associated ovarian cancer treated with three or more prior lines of chemotherapy. Patients received olaparib at a dose of 400 mg by mouth twice daily until disease progression or unacceptable toxicity. The objective response rate (ORR) was 34% with median response duration of 7.9 months in this cohort. The most common adverse reactions (≥20%) in patients treated with olaparib were anemia, nausea, fatigue (including asthenia), vomiting, diarrhea, dysgeusia, dyspepsia, headache, decreased appetite, nasopharyngitis/pharyngitis/upper respiratory infection, cough, arthralgia/musculoskeletal pain, myalgia, back pain, dermatitis/rash, and abdominal pain/discomfort. Myelodysplatic syndrome and/or acute myeloid leukemia occurred in 2% of the patients enrolled on this trial. Clin Cancer Res; 21(19); 4257–61. ©2015 AACR.

[1]  References , 1971 .

[2]  J. Thigpen,et al.  Phase II trial of paclitaxel in patients with progressive ovarian carcinoma after platinum-based chemotherapy: a Gynecologic Oncology Group study. , 1994, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[3]  Steven E. Bayer,et al.  A strong candidate for the breast and ovarian cancer susceptibility gene BRCA1. , 1994, Science.

[4]  D. Bentley,et al.  Identification of the breast cancer susceptibility gene BRCA2 , 1995, Nature.

[5]  F. Parazzini,et al.  Survival and determinants of response to third-line chemotherapy in sensitive recurrent ovarian cancer patients. , 1999, British journal of cancer.

[6]  A. D’Andrea,et al.  The Fanconi anaemia/BRCA pathway , 2003, Nature Reviews Cancer.

[7]  D. Gershenson,et al.  Third‐line chemotherapy in platinum‐ and paclitaxel‐resistant ovarian, fallopian tube, and primary peritoneal carcinoma patients , 2004, International journal of gynecological cancer : official journal of the International Gynecological Cancer Society.

[8]  J. Krischer,et al.  BRCA1 and BRCA2 mutations account for a large proportion of ovarian carcinoma cases , 2005, Cancer.

[9]  B. Friedenson,et al.  The BRCA1/2 pathway prevents hematologic cancers in addition to breast and ovarian cancers , 2007, BMC Cancer.

[10]  T. Kasamatsu,et al.  Usefulness of third-line chemotherapy for women with recurrent ovarian, fallopian tube, and primary peritoneal cancer who receive platinum/taxane regimens as first-line therapy , 2009, Journal of Cancer Research and Clinical Oncology.

[11]  E. Friedman,et al.  Effect of BRCA1/2 mutations on long-term survival of patients with invasive ovarian cancer: the national Israeli study of ovarian cancer. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[12]  Barry Rosen,et al.  Frequencies of BRCA1 and BRCA2 mutations among 1,342 unselected patients with invasive ovarian cancer. , 2011, Gynecologic oncology.

[13]  Gord Glendon,et al.  Association Between BRCA1 and BRCA2 Mutations and Survival in Women With Invasive Epithelial Ovarian Cancer , 2012 .

[14]  J. George,et al.  BRCA mutation frequency and patterns of treatment response in BRCA mutation-positive women with ovarian cancer: a report from the Australian Ovarian Cancer Study Group. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[15]  J. Thigpen Olaparib Maintenance Therapy in Platinum-Sensitive Relapsed Ovarian Cancer , 2012 .

[16]  Y. Pommier,et al.  Trapping of PARP1 and PARP2 by Clinical PARP Inhibitors. , 2012, Cancer research.

[17]  A. Fishman,et al.  Advanced (>second) line chemotherapy in the treatment of patients with recurrent epithelial ovarian cancer. , 2013, European journal of obstetrics, gynecology, and reproductive biology.

[18]  A. Reuss,et al.  Bevacizumab combined with chemotherapy for platinum-resistant recurrent ovarian cancer: The AURELIA open-label randomized phase III trial. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[19]  D. Matei,et al.  Olaparib maintenance therapy in patients with platinum-sensitive relapsed serous ovarian cancer: A preplanned retrospective analysis of outcomes by BRCA status in a randomised phase 2 trial , 2014 .

[20]  Ayala Hubert,et al.  Olaparib monotherapy in patients with advanced cancer and a germline BRCA1/2 mutation. , 2015, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[21]  A. Jimeno,et al.  FGFR1 Expression Levels Predict BGJ398 Sensitivity of FGFR1-Dependent Head and Neck Squamous Cell Cancers , 2015, Clinical Cancer Research.