Parp Inhibitor Use for subsequent remission

Deletedbyrequest

I am just wondering if anyone used a parp inhibitor after remission; then had a first recurrance; then used a parp inhibitor for the second time.  Or if you were switched to a different maintenance drug ?

Strongwoman

@Cecile21
  That is a good question.  I am positive one of the ladies that have utilized the PARP Inhibitors will get back to you shortly on this.  
  I will look forward to reading about it when it gets posted.

Fearless_Moderator

@Cecile21 Good question.  I was on Olaparib for almost 2 years to treat my first recurrence but for me it was a controlled clinical trial.  That said, after I recurred again and went through chemo I was told I couldn't qualify for a PARP for maintenance since it had run its course with me.  I'm not sure if it's a medical decision or related to the criteria the Ontario MOH requires they follow to have the drug qualify for use.  I can say I can't recall a single post here where anyone mentions they we able to switch drugs. There may be some, now that some of the PARPs have been more formally approved for use who have received it after a subsequent recurrence again but also can't recall anyone mentioning that.  

If you haven't already, I'd suggest you ask your oncologist, especially if you're lucky enough to have one that 's a medical oncologist,  Like Strongwoman I'd be interested to see if you get any replies or your research turns up any information on the topic.  Thanks for raising it.

GloHo

@Cecile21

I find myself heading in that direction right now.

Diagnosis #1...chemo (6 treatments)...2 1/2 years NED...Recurrence #1...chemo (11 treatments)...Zejula (2 months)...CA125 increased quite a bit and CT showed progression

I have an appointment with my Dr. on Monday. The plan is back to chemo -  with carbo (weekly) + Caelyx or Bevacizumab (bi-weekly), followed by maintenance with either Caelyx or Bev. Will be confirmed on Monday.

I was going to ask if I could go back on Zejula or not because I've seen some posts where Zejula + Bev have been used for maintenance.

Will keep you updated.

Deletedbyrequest

With regard to chemo, then Zejula, then recurrance.  First to note that even with recurrance as defined by CT, my CA125 has not gone above 20. My oncologist does not seem to think that Zejula would be of any use for me ( my first remission was 2 years HGSOC with Zejula) as he believes that it is now not effective. HOWEVER my understanding is that Windsor is not a main centre for reproductive cancers. I was diagnosed in Mississauga and referred to London where I had my debulking surgery done. My referral to Windsor was for Chemo, since it was only 30 mins from home as opposed to 2 hrs. I have questioned my oncologist about this and he indicated that he would contact a colleague. I am sttage IV so I would hope that there is some sort of maintenance therapy for me. 

Fearless_Moderator

@Cecile21 I know how confusing it can be getting transfered to a satellite and the lack of specific expertise you encounter at them.  With all due respect chemo is chemo and the expertise would be there for that purpose but beyond that I would ask for a referral to a \Medical Oncologist at a Regional Cancer centre (that may be Juravinski in Hamilton) to discuss options that might be available to you to slow down or stop progression of the disease.  It's just a consult to weigh options so no one should be offended about the ask.  Good luck. Hoping you'll get some answers. 

GloHo

@Cecile21

Hi again. Sorry for the delay. I feel like I've been taking one step forward and then careening two steps back lately!! My oncologist retired and I had an interim Dr, my new oncologist has just started and things are now moving forward!!

Was on Zejula for two months following my second round of carbo+taxol. Zejula didn't work and CT showed my cancer has progressed. Since my recurrence was under 6 months, I am now considered platinum-resistant. (I am BRCA-negative.) 

My new course of action is Caelyx + Avistan (Bevacizumab). Avistan every two weeks + Caelyx every 28 days. A return to Zejula alone and/or with another drug was not an option. 

@Fearless_Moderator makes a good point about reaching out to a Medical Oncologist to determine what options are available and the best fit for you. 

I have also advised my oncologist that I would be interested in a clinical trial. Not sure how all that works, but I have been looking at some info available online but haven't done a deep dive into the specific trials yet.

Keep us posted.

 

ellie

Hi,
Joining in on this conversation but late.  Research supports low efficacy for PARP inhibitors on recurrence.  And research indicates that Overall Survival can be reduced by taking PARP inhibitors after recurrence.  In considering any research, one has to keep in mind that PARP research tends to channel HGSOC participants into groups of BCRA+/HRD positive (couple of groups) and BCRA negative/HRD negative.  Participants in the first 2 groups have better outcomes than HGSOC participants in the latter group who--and I am in that latter group.  I am still in NRD status and taking a PARP inhibitor but am not sure if indeed it is helping.  Time will tell.

GloHo

@ellie
Interesting info for sure! Thanks for sharing and good luck on your maintenance treatment with PARP! 🤞