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Stop PARP inhibitors early in women whose blood shows no residual tumour DNA, and extend or switch in those whose ctDNA persists or reverts BRCA.
The two-year duration of olaparib maintenance in SOLO-1 and the three-year duration of niraparib in PRIMA were set by trial design rather than biology, so this idea proposes letting serial ctDNA decide how long each woman with ovarian cancer stays on a PARP inhibitor. Patients who are ctDNA-negative at twelve months would stop, while those with persistent ctDNA or a BRCA reversion mutation in plasma would switch to an ATR or POLQ inhibitor before radiographic progression. The rationale is that MRD-guided de-escalation has been shown in DYNAMIC and IMvigor011, and that BRCA reversion, the main resistance mechanism, is detectable in blood months before imaging relapse. The proposed test is a randomised de-escalation trial with tumour-informed ctDNA, and the idea remains speculative.
Niraparib is approved as first-line maintenance for all comers, making PARP inhibitor maintenance available beyond BRCA-mutated disease, though the benefit in proficient tumours is modest and long-term survival data are neutral.
Every woman diagnosed with advanced high-grade ovarian cancer should be tested for BRCA mutations at diagnosis, because those who carry one should receive two years of olaparib after chemotherapy, which greatly extends the time in remission and improves long-term survival. The plateau in the survival curves suggests some patients are cured by this approach. Toxicity is mostly anaemia, fatigue and nausea, and the two-year limit appears sufficient.
One of the most cited trial reports Europe PMC returns for Niraparib in Ovarian cancer, so it is a natural first reading for anyone weighing the idea it is linked from. The record was linked automatically by title and abstract; read the abstract above and the paper itself before relying on any figure.
Shares SOLO-1, SOLO-1: two years of olaparib maintenance after first-line chemotherapy for BRCA-mutated ovarian cancer, PARP inhibitors, Olaparib.
Shares SOLO-1: two years of olaparib maintenance after first-line chemotherapy for BRCA-mutated ovarian cancer, Niraparib, Olaparib, Ovarian cancer.
Shares Platinum-sensitive ovarian cancer, PARP inhibitors, Olaparib, Ovarian cancer.
Shares Platinum-sensitive ovarian cancer, PARP inhibitors, Olaparib, Ovarian cancer.
Shares Platinum-sensitive ovarian cancer, Niraparib, PARP inhibitors, Ovarian cancer.
Shares Platinum-sensitive ovarian cancer, PARP inhibitors, Olaparib, Ovarian cancer.
Shares Niraparib, PARP inhibitors, Ovarian cancer.
Shares Niraparib, PARP inhibitors, Ovarian cancer.