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About This Activity

Activity Description and Learning Objectives

In this activity, experts in ovarian cancer discuss the use of PARP inhibitors as maintenance treatment in advanced ovarian cancer.

This activity has been jointly provided by Oakstone and touchIME ONCOLOGY. Oakstone Publishing is accredited by the ACCME to provide continuing medical education to physicians.

After watching this activity, participants should be better able to :

Target Audience

This activity has been designed to meet the educational needs of oncologists and oncology nurses.

Disclosures

Oakstone Publishing has assessed conflict of interest with its faculty, authors, editors, and any individuals who were in a position to control the content of this CME activity. Any identified relevant conflicts of interest were resolved for fair balance and scientific objectivity of studies utilized in this activity. Oakstone Publishing’s planners, content reviewers, and editorial staff disclose no relevant commercial interests.

Faculty

Dr Banerjee disclosures: Grants/research support from AstraZeneca and GlaxoSmithKline. Consultant/advisory boards for Amgen, AstraZeneca, Clovis, Genmab, GlaxoSmithKline, Roche and Seattle Genetics.

Dr González-Martín disclosures: Grants/research support from Roche and Tesaro/GlaxoSmithKline. Consultant/advisory boards for Amgen, AstraZeneca, Clovis, Genmab, Immunogen, MSD, Novartis, Oncoinvent, Pfizer/Merck, Roche, Tesaro/GlaxoSmithKline. Speakers Bureau for AstraZeneca, Pharmamar, Roche and Tesaro/GlaxoSmithKline.

Dr Moore disclosures: Grants/research support from Lilly, Genentech, Merck and PTC Therapeutics. Consultant/advisory boards for AbbVie, Aravive, AstraZeneca, Eisai, GlaxoSmithKline/Tesaro, Genentech/Roche, Immunogen, Merck, Mersana, Tarveda and VBL Therapeutics.

Content Reviewer

Walter Murray Yarbrough, MD, FACP, has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Hannah Fisher has no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Oakstone Publishing and touchIME. Oakstone Publishing is accredited by the ACCME to provide continuing medical education for physicians.

Oakstone Publishing designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In order to receive credit for this activity, participants must review and complete the post-test and evaluation form. A score of 70% or higher is needed to obtain CME credit. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 Credit™ into European CME credit (ECMEC) should contact the UEMS (www.uems.eu)

Date of original release: June 04, 2020. Date credits expire: June 04, 2021.

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Q1. Which Phase III study investigated the activity of PARP inhibitor first-line maintenance monotherapy following platinum-based chemotherapy in patients with either BRCAm or BRCAwt ovarian cancer?

  1. A. SOLO-1
  2. B. PRIMA
  3. C. PAOLA-1
  4. D. VELIA

Please try again

SOLO-1 (olaparib) only included patients with BRCAm tumours, PAOLA-1 (olaparib) investigated PARP inhibitor maintenance treatment in combination with bevacizumab, and VELIA (veliparib) assessed a combination of a PARP inhibitor and chemotherapy followed by PARP inhibitor maintenance treatment. PRIMA (niraparib) investigated PARP inhibitor maintenance monotherapy and did not exclude patients on the basis of BRCA status

BRCAm/wt, BReast CAncer gene mutated/wild type; PARP, poly(adenosine diphosphate-ribose) polymerase

References
Moore K, et al. New Engl J Med. 2018;379:2495–505.
Ray-Coquard I, et al. New Engl J Med. 2019;381:2416–28.
Coleman RL, et al. N Engl J Med. 2019;381:2403–15.
González-Martín A, et al. New Engl J Med. 2019;381:2391–402.

Q2. Mutations in which of the following genes are commonly categorized as homologous recombination repair gene mutations in ovarian cancer?

  1. A. BRCA1 but not BRCA2
  2. B. BRCA1/2 and HER2
  3. C. Germline but not somatic BRCA mutations
  4. D. BRCA1/2, Fanconi anaemia pathway genes and TP53

Please try again

The HRR group of genes includes BRCA, Fanconi anaemia pathway genes, mismatch repair genes and TP53.

BRCA, BReast CAncer gene; HER2, human epidermal growth factor receptor 2; HRR, homologous recombination repair

Reference
Frey MK and Pothuri B. Gynecol Oncol Res Pract. 2017;4:4.

Q3. Which rare adverse events should physicians be aware of in the context of PARP inhibitor first-line maintenance therapy?

  1. A. Neutropenia and asthenia/fatigue
  2. B. Pneumonitis and thrombocytopenia
  3. C. AML, MDS and pneumonitis
  4. D. Anaemia and nausea

Please try again

MDS/AML (<1.5%) and pneumonitis (<1%) are identified as special warnings in the PI/SmPC for olaparib and niraparib. Neutropenia, asthenia/fatigue, thrombocytopenia, anaemia and nausea are adverse events which may be associated with PARP inhibitors but they are not considered to be rare events.

AML, acute myeloid leukaemia; MDS, myelodysplastic syndrome; PARP, poly(adenosine diphosphate-ribose) polymerase; PI, prescribing information; SmPC, Summary of Product Characteristics

References
Olaparib Prescribing Information revised 12/2019.
Olaparib Summary of Product Characteristics updated 11/2019.
Niraparib Prescribing Information revised 04/2020.

Q4. Your patient has BRCAwt ovarian cancer and is receiving first-line platinum chemotherapy. You have discussed the option of PARP inhibitor maintenance treatment and agree that this will be initiated when she completes chemotherapy. She weighs 82 kg and her platelet count is 155,000/mm3. In view of the available Phase III data for PARP inhibitor first-line maintenance, what would you recommend, assuming that all PARP inhibitors were available for use?

  1. A. Niraparib 200 mg once daily
  2. B. Niraparib 300 mg once daily
  3. C. Olaparib 300 mg twice daily
  4. D. Veliparib 300 mg twice daily

Please try again

The standard dose of niraparib is 300 mg once daily, and 200 mg once daily for patients with bodyweight <77 kg, platelets <150,000/mm3 , or both. Phase III data for first-line olaparib monotherapy maintenance treatment describe patients with BRCAm tumours, and Phase III data for veliparib maintenance therapy apply to patients who received veliparib alongside chemotherapy followed by maintenance treatment with veliparib.

BRCAm/wt, BReast CAncer gene mutated/wild type; PARP, poly(adenosine diphosphate-ribose) polymerase

References
González-Martín A, et al. New Engl J Med. 2019;381:2391–402.
Moore K, et al. New Engl J Med. 2018;379:2495–505.
Coleman RL, et al. N Engl J Med. 2019;381:2403–15.

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Credit Back to Education Zone

touchPANEL DISCUSSION

PARP inhibitor maintenance treatment in advanced ovarian cancer: The who, what and how?

Introduction

Watch a panel of internationally renowned ovarian cancer experts discuss the use of PARP inhibitors for maintenance treatment in advanced ovarian cancer.

Dr Susana Banerjee chairs a discussion with Dr Antonio González-Martín and Dr Kathleen Moore, where they consider the latest data for PARP inhibitors in first-line maintenance treatment and how this may influence clinical practice, as well as factors that affect the choice of PARP inhibitor for each patient and the management of possible adverse events.

This activity is intended for oncologists and oncology nurses.

This touchPANEL DISCUSSION was recorded in May 2020.

Learning Objectives

After watching this touchPANEL DISCUSSION, you should be able to:

  • Describe the latest data for PARP inhibitors in the first-line maintenance treatment setting
  • Discuss approaches to select the most appropriate PARP inhibitor for each patient
  • Interpret safety data for PARP inhibitors to help mitigate and manage adverse events

Clinical Spotlight

  • What do we know about the use of PARP inhibitors in first-line maintenance treatment?
  • Which factors influence the choice of PARP inhibitor for maintenance treatment?
  • How can adverse events be proactively managed to improve quality of life for patients?

Clinical Spotlight

  • What do we know about the use of PARP inhibitors in first-line maintenance treatment?
  • Which factors influence the choice of PARP inhibitor for maintenance treatment?
  • How can adverse events be proactively managed to improve quality of life for patients?

The Expert Panel

DR SUSANA BANERJEE

DR ANTONIO GONZÁLEZ-MARTÍN

DR KATHLEEN MOORE

DR SUSANA BANERJEE

Susana Banerjee (MBBS MA PhD FRCP) is a Consultant Medical Oncologist and Research Lead for the Gynaecology Unit at The Royal Marsden NHS Foundation Trust, London, UK. She is also Reader in Women’s Cancers at the Institute of Cancer Research. Dr Banerjee specializes in ovarian cancer and the systemic treatment of endometrial and cervical cancers.

Dr Banerjee graduated with a first class from St. John’s College, University of Cambridge. She gained a PhD from the Institute of Cancer Research, University of London, and completed specialist training at The Royal Marsden.

Dr Banerjee has been involved in several national and international specialist groups including the National Cancer Research Institute (NCRI) Gynaecological Cancers Clinical Studies Group, European Organization for Research and Treatment of Cancer (EORTC) Executive Steering Committee for Gynaecological Cancers, and the European Society of Gynaecological Oncology (ESGO) Congress Faculty. Dr Banerjee serves on the European Society of Medical Oncology (ESMO) Executive Board. She was the Track Chair for Gynaecological Cancers at the ESMO Congress 2018 and Scientific Co-chair for ESMO Asia 2018.

Dr Banerjee is an author of over 100 peer-reviewed articles and is actively involved in clinical trials and translational research. Dr Banerjee is UK Chief Investigator and Principal Investigator at The Royal Marsden for multiple national and international clinical trials. Her research interests include individualization of patient treatment, targeted therapies (including PARP inhibitors) and rare gynaecological cancers.

Disclosures: Grants/research support from AstraZeneca and GlaxoSmithKline. Consultant/advisory boards for Amgen, AstraZeneca, Clovis, Genmab, GlaxoSmithKline, Roche and Seattle Genetics.

DR ANTONIO GONZÁLEZ-MARTÍN

Antonio González-Martín graduated in medicine from the University of Navarra in Pamplona, Spain, and subsequently trained in medical oncology at University Hospital Ramón y Cajal in Madrid, Spain, from 1994 to 1997. During part of 1997 he attended as an observer The Mount Sinai School of Medicine in New York, USA.

He joined as staff member of the Medical Oncology Service at University Hospital Ramón y Cajal in 1998. From January 2009 he was Head of the Medical Oncology Department at MD Anderson Cancer Center Madrid, an affiliate institution of the MD Anderson Cancer Center in Houston, USA.

Since September 2017, he has been Head of Medical Oncology and Co-Director of the Oncology Department at the Clínica Universidad de Navarra in Madrid. He is Associate Professor of Medicine at Francisco de Vitoria University in Madrid and Adjunct Professor at the University of Texas in the USA. He gained his PhD degree at Francisco de Vitoria University in April 2018.

He specializes in the treatment of gynaecological and breast cancer and is the Chairman of the Spanish group for investigation in ovarian and gynaecological cancer (GEICO). He is also the representative of GEICO in the European Network for Gynaecological Oncological Trials (ENGOT), and was the President of ENGOT for the period 2018–2020. In addition, he is one of the representatives of GEICO in the Gynaecologic Cancer InterGroup and Chair of the ovarian cancer committee. He is also a member of the board of the Spanish Society of Medical Oncology (SEOM), and a member of the GEICAM and SOLTI breast cancer cooperative groups.

He has several relevant publications in the field of gynaecological and breast cancer. He is considered an expert in gynaecological cancer and has lectured widely on these areas of interest.

Disclosures: Grants/research support from Roche and Tesaro/GlaxoSmithKline. Consultant/advisory boards for Amgen, AstraZeneca, Clovis, Genmab, Immunogen, MSD, Novartis, Oncoinvent, Pfizer/Merck, Roche, Tesaro/GlaxoSmithKline. Speakers Bureau for AstraZeneca, Pharmamar, Roche and Tesaro/GlaxoSmithKline.

DR KATHLEEN MOORE

Kathleen Moore is an Associate Professor in the section of gynaecologic oncology and serves as the Director of the Oklahoma TSET Phase I Clinical Trials Program, Oklahoma’s only Phase I clinical trials programme. She is the Jim and Christy Everest Endowed Chair in Cancer Research as well as the Director of the Gynecologic Oncology Fellowship Program. She also serves as the Associate Director of Clinical Research and Medical Director of the Clinical Trials Office for the Stephenson Cancer Center, Oklahoma, USA.

Dr Moore has published more than 200 peer-reviewed articles and serves on the editorial board for four academic publications. She has a clinical research interest in drug development and Phase I trials.

She attended medical school at the University of Washington School of Medicine and completed her residency in obstetrics and gynaecology at the University Health Center of Pittsburgh. Dr Moore completed a fellowship in gynaecologic oncology at the University of Oklahoma Health Sciences Center, while simultaneously earning a master’s degree in epidemiology.

She is board certified in obstetrics and gynaecology as well as gynaecologic oncology, and hospice and palliative care.

Disclosures: Grants/research support from Lilly, Genentech, Merck and PTC Therapeutics. Consultant/advisory boards for AbbVie, Aravive, AstraZeneca, Eisai, GlaxoSmithKline/Tesaro, Genentech/Roche, Immunogen, Merck, Mersana, Tarveda and VBL Therapeutics.

About This Activity

Activity Description and Learning Objectives

In this activity, experts in ovarian cancer discuss the use of PARP inhibitors as maintenance treatment in advanced ovarian cancer.

This activity has been jointly provided by Oakstone and touchIME ONCOLOGY. Oakstone Publishing is accredited by the ACCME to provide continuing medical education to physicians.

After watching this activity, participants should be better able to :

  • Describe the latest data for PARP inhibitors in the first-line maintenance treatment setting
  • Discuss approaches to select the most appropriate PARP inhibitor for each patient
  • Interpret safety data for PARP inhibitors to help mitigate and manage adverse events

Target Audience

This activity has been designed to meet the educational needs of oncologists and oncology nurses.

Disclosures

Oakstone Publishing has assessed conflict of interest with its faculty, authors, editors, and any individuals who were in a position to control the content of this CME activity. Any identified relevant conflicts of interest were resolved for fair balance and scientific objectivity of studies utilized in this activity. Oakstone Publishing’s planners, content reviewers, and editorial staff disclose no relevant commercial interests.

Faculty

Dr Banerjee disclosures: Grants/research support from AstraZeneca and GlaxoSmithKline. Consultant/advisory boards for Amgen, AstraZeneca, Clovis, Genmab, GlaxoSmithKline, Roche and Seattle Genetics.

Dr González-Martín disclosures: Grants/research support from Roche and Tesaro/GlaxoSmithKline. Consultant/advisory boards for Amgen, AstraZeneca, Clovis, Genmab, Immunogen, MSD, Novartis, Oncoinvent, Pfizer/Merck, Roche, Tesaro/GlaxoSmithKline. Speakers Bureau for AstraZeneca, Pharmamar, Roche and Tesaro/GlaxoSmithKline.

Dr Moore disclosures: Grants/research support from Lilly, Genentech, Merck and PTC Therapeutics. Consultant/advisory boards for AbbVie, Aravive, AstraZeneca, Eisai, GlaxoSmithKline/Tesaro, Genentech/Roche, Immunogen, Merck, Mersana, Tarveda and VBL Therapeutics.

Content Reviewer

Walter Murray Yarbrough, MD, FACP, has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Hannah Fisher has no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Oakstone Publishing and touchIME. Oakstone Publishing is accredited by the ACCME to provide continuing medical education for physicians.

Oakstone Publishing designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In order to receive credit for this activity, participants must review and complete the post-test and evaluation form. A score of 70% or higher is needed to obtain CME credit. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 Credit™ into European CME credit (ECMEC) should contact the UEMS (www.uems.eu)

Date of original release: June 04, 2020. Date credits expire: June 04, 2021.