Factors affecting PARP inhibitor use as maintenance treatment in platinum-sensitive recurrent ovarian cancer

Abstract

<h3>Objectives:</h3> Poly(ADP-ribose) polymerase inhibitors (PARPi) have demonstrated efficacy in ovarian cancer (OC). Since December 2014, several PARPi have been approved as third- or fourth-line treatment agents, as well as maintenance treatment, in patients with platinum-sensitive recurrent OC (PSROC), and maintenance treatment in front-line OC. Factors affecting PARPi use in the maintenance setting and potential population-specific disparities in PARPi use are unknown. The aim of this study was to explore if age or other factors influence the use of PARPi maintenance treatment in PSROC. <h3>Methods:</h3> This retrospective real-world study used the Flatiron Health database, a longitudinal, demographically and geographically diverse electronic health record-derived, de-identified database from ~280 cancer clinics nationwide (~800 sites of care) representing US cancer patients. Patients diagnosed with invasive ovarian, fallopian tube, and/or primary peritoneal cancer, collectively referred to as OC, from January 1, 2011, to July 31, 2020, who received ≥2 lines of platinum-based treatment, were platinum sensitive, and did not receive prior PARPi, were included. PARPi use as PSROC maintenance was compared using a chi-square test or t-test across several factors, including <i>BRCA</i> mutational (<i>BRCA</i>m) status, age, race, practice setting, and geographical location. <h3>Results:</h3> We identified 545 patients who met the inclusion criteria. Of those, 203 (37%) received PARPi maintenance. Of the 84 patients with BRCAm, 53 (63%) received a PARPi (Table). In contrast, of the 361 <i>BRCA</i> wild-type (BRCAwt) patients, 119 (33%) received PARPi. Patients with a <i>BRCA</i>m were more likely to be treated with a PARPi vs patients who were <i>BRCA</i>wt (<i>P</i><0.0001) (Table). Patients <65 years old were more likely to be treated with a PARPi vs patients ≥65 (P=0.0063). Among the 212 patients <65 years old, 44% received PARPi maintenance, and of the 333 patients ≥65, 33% received PARPi maintenance (Table). There was no statistically significant difference in PARPi use by race, practice type, or geographic region (Table). <h3>Conclusions:</h3> In this real-world study, <i>BRCA</i>m status and younger age were associated with the use of PARPi as maintenance treatment in PSROC. No other factor included in this analysis was found to be associated with disparities in the use of PARPi maintenance. However, PARPi uptake still needs improvement across all groups.Funding: GlaxoSmithKline, Waltham, MA, United States