Study Shows High Clinical and Financial Burden of PARP Inhibitors

According to one study, real-world experience with PARP inhibitors reveals more dose interruptions, reductions, and discontinuations for toxicity management among women with gynecologic cancers than has been previously reported in clinical trials. The toxicity profile, however, was consistent with previous reports from clinical studies. This research was presented in a poster by Cortney Eakin, MD, from Arizona Oncology Associates, at the Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer.

“The clinical and financial burden of PARP inhibitors may be significant,” reported Dr Eakin. “Future studies should assess the impact on patient outcomes.”

Three different PARP inhibitors have been granted 6 FDA approvals within the past 5 years, leading to their rapid integration into treatment plans among community oncology practices. Dr Eakin and colleagues sought to describe the commonality of the use of PARP inhibitors, as well as the clinical and financial burdens associated with them, in a typical community oncology practice.

The investigators used a retrospective chart review to identify patients from 12 gynecologic oncologists between December 2016 and November 2018 who were using olaparib, niraparib, or rucaparib for maintenance therapy or treatment of recurrent ovarian, primary peritoneal, or fallopian tube cancer. They extracted demographic, financial, and clinical data, and described each course separately for patients treated with >1 PARP inhibitors.

A total of 47 patients with a median age of 66 years and 506 PARP cycles were identified (24%, olaparib; 18%, rucaparib; 58%, niraparib). Sixty-four percent of patients had received ≥3 prior platinum-based chemotherapy regimens, and 65% of patients had ≥2 comorbid conditions. All patients were insured: 17.7% had federal insurance, 46.7% had private insurance, and 35.6% had dual coverage.

The researchers documented a total of 711 phone calls to care providers, for a call rate of 1.4 calls per cycle. Care coordination required the highest call rate, followed by laboratory results and toxicity management.

The incidence of grade ≥3 adverse events was similar to that reported in prior clinical trials, at a rate of 24% overall (17%, olaparib; 27%, rucaparib; 25%, niraparib).

Overall, 69% of patients required dose interruption (67%, olaparib; 64%, rucaparib; 71%, niraparib), 63% required dose reduction (58%, olaparib; 45%, rucaparib; 71%, niraparib), and 29% required discontinuation due to toxicity (42%, olaparib; 45%, rucaparib; 18%, niraparib).

The mean duration of PARP inhibitor therapy was 7.46 cycles; most cycles were olaparib, followed by niraparib and rucaparib.

The average cost of PARP inhibitor therapy was $8018 per cycle: $9022 for rucaparib, $8067 for niraparib, and $7780 for olaparib, with the average total cost of PARP inhibitor treatment totaling $67,139.

Based on these data, the investigators maintain that the clinical and financial burden of PARP inhibitors may be significantly underrated among patients with gynecologic cancers, and future studies should focus on the impact of these burdens on patient outcomes.

  • SGO 2020 Annual Meeting on Women’s Cancer. Abstract 294.

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