Practical aspects of treating relapsed BRCA-associated ovarian cancer

Abstract

Ovarian cancer ranks first in the mortality causes pattern of female reproductive cancers in Russia. Treatment of relapsed ovarian cancer remains a significant challenge to practicing oncologists. Introduction of PARP inhibitors in clinical practice are the most significant achievements in this area. The use of drugs of this class significantly reduced the relative risk of tumour progression in relapsed ovarian cancer and increased the relapse-free duration. At the same time, many issues related to the practical use of PARP inhibitors remain unresolved. This review presents practical approaches to determining the categories of patients, who receive the greatest benefit from the use of drugs of this class. The article addresses epidemiology of BRCA-associated ovarian cancer. The authors presented information on modern methods for genetic testing, classification of mutations depending on proposed class of pathogenicity, and reviews the problems associated with identification of «variants of unknown clinical relevance». The mechanisms of action of PARP inhibitor are described in detail here. The evidence base demonstrating the efficacy and safety of olaparib, the only PARP inhibitor approved for clinical use in the Russian Federation as supportive therapy for platinum-sensitive relapsed BRCA-associated ovarian cancer, is discussed. The article detailed information on the spectrum of potential toxicity that is most commonly faced by oncologists prescribing olaparib and other PARP inhibitors. The main aspects of management of adverse events during olaparib therapy are also presented.