Study: Niraparib increases progression-free survival in patients with newly diagnosed ovarian cancer
|At a glance||In-depth|
|Clinical trials||Resources and references|
|Questions for your doctor|
This study is about:
The use of niraparib (Zejula) as maintenance therapy (a therapy that is designed to keep cancer from coming back after a successful first therapy) for newly diagnosed ovarian cancer patients.
Why is this study important?
The PRIMA trial looked at the effectiveness and safety of niraparib as maintenance therapy after a response to chemotherapy (before recurrence) in women with newly diagnosed ovarian cancer.
Women who received niraparib had a longer progression-free survival (amount of time until their cancer came back or got worse) than those who received a placebo.
- For patients who received niraparib, the average progression-free survival was 13.8 months compared to 8.2 months for patients who received a placebo.
- After two years, the rate of overall survival was 84% for patients who received niraparib compared to 77% for patients who received a placebo.
- The most common side effects were anemia (decrease in red blood cells), thrombocytopenia (decrease in blood platelets which help healing), and neutropenia (decrease in neutrophils which help fight infection).
What does this mean for me?
The results of this study suggest that niraparib, when used as maintenance therapy, may increase progression-free survival.
This article is relevant for:
Women newly-diagnosed with ovarian cancer
This article is also relevant for:
Ovarian cancer survivors
Be part of XRAY:
- I have finished my first-line treatment. Should I consider maintenance therapy?
- What are my options for maintenance therapy after chemotherapy?
- What type of side effects should I expect on a PARP inhibitor?
- NCT03522246: A Study in Ovarian Cancer Patients Evaluating Rucaparib and Nivolumab as Maintenance Treatment Following Response to Front-Line Platinum-Based Chemotherapy (ATHENA). ATHENA is a study for women who are newly diagnosed with ovarian cancer. The goal of ATHENA is to look at whether giving maintenance therapy with different agents improves outcomes for women who have completed front-line treatment.
- NCT03326193. A Study of Niraparib Combined With Bevacizumab Maintenance Treatment in Patients With Advanced Ovarian Cancer Following Response on Front-Line Platinum-Based Chemotherapy. This clinical trial will evaluate the safety and efficacy of niraparib (also known as Zejula, a PARP inhibitor) in combination with bevacizumab (avastin) in women with Stage IIIB to IV ovarian cancer who have a complete response, partial response, or no evidence of disease following front-line, platinum-based chemotherapy with bevacizumab.
- NCT02855944. ARIEL4: A Study of Rucaparib Versus Chemotherapy BRCA Mutant Ovarian, Fallopian Tube, or Primary Peritoneal Cancer Patients. ARIEL4 is a treatment study for women with relapsed, high-grade epithelial ovarian, fallopian tube, or primary peritoneal cancer who have a BRCA1 or BRCA2 mutation. ARIEL4 is designed to evaluate rucaparib against standard of care chemotherapy in women who have had at least two prior chemotherapy regimens.
- NCT02983799. Olaparib Tablets as a Treatment for Ovarian Cancer Subjects With Different HRD Tumor Status. This study will look at olaparib (Lynparza) tablets as a treatment for relapsed ovarian cancer in women with, or without a BRCA mutation. Patients should have received at least 2 prior lines of platinum-based chemotherapy. All participants will receive the study agent, olaparib.
Additional ovarian cancer clinical trials can be found here.
Note: Enrollment for the PRIMA trial has been reached. This study is no longer enrolling patients.
Who covered this study?
IN-DEPTH REVIEW OF RESEARCH
Clinical benefit with PARP inhibitors has been observed for patients with BRCA mutations, in both the up-front setting and the recurrent setting. Some recent trials have shown that niraparib is effective in some patients with normal BRCA genes in their tumors. These trials resulted in two FDA approvals:
- In 2017 niraparib was approved as a maintenance treatment for women with recurrent ovarian cancer who responded to platinum-based chemotherapy, even in the absence of a germline or somatic BRCA mutation.
- In 2019, niraparib was approved as fourth-line therapy for women with advanced ovarian cancer with a type of DNA repair deficiency called homologous recombination deficiency (HRD).
The researchers conducting the PRIMA trial wanted to know if the observed clinical benefit of niraparib could be extended to all patients with advanced ovarian cancer including those patients whose tumors had HRD (with or without a BRCA mutation) and those patients whose tumors did not have HRD.
Researchers of this study wanted to know:
How well niraparib works as a maintenance therapy following front-line platinum-based chemotherapy in patients with Stage III or IV ovarian cancer (including fallopian and peritoneal cancers).
- The primary end-point was progression-free survival in both patients whose tumors had HRD and in patients in the overall population.
- The secondary end-point was overall survival.
Populations looked at in this study:
This study randomized 733 newly diagnosed ovarian cancer patients to receive niraparib (487 patients) or a placebo or sugar pill (246 patients) once daily following chemotherapy.
Of the patients who were randomized and received either niraparib or a placebo:
- 373/733 (51%) had tumors with HRD with Myriad’s myChoice testing.
- 223/373 (60%) had tumors with a BRCA mutation (either inherited or acquired).
- 150/373 (40%) had tumors without a BRCA mutation.
This phase III trial was conducted in 20 countries at 181 clinical sites from July 2016-June 2018. Within 12 weeks of completing the last dose of chemotherapy, patients were randomized in a 2:1 ratio to receive oral niraparib or a placebo once daily for 36 months or until their disease progressed. Computed tomography (a form of tomography in which a computer controls the X-ray source and detectors, processes the data and produces the image) or MRI was used to assess disease every 12 weeks until the treatment ended or was discontinued.
Among the 373 patients whose tumors had HRD:
- The median progression-free survival was longer in the niraparib group than in the placebo group (21.9 months v. 10.4 months).
- In the BRCA-mutated group (a subset of the HRD group), median progression-free survival was longer in the niraparib group than in the placebo group (19.6 months v 8.2 months).
In the overall population (all 733 patients):
- The median progression-free survival was longer in the niraparib group than in the placebo group (13.8 months vs. 8.2 months).
- At 24 months, the rate of overall survival was 84% in the niraparib group and 77% in the placebo group.
The most common adverse events were anemia (decrease in red blood cells), thrombocytopenia (decrease in blood platelets which help healing), and neutropenia (decrease in neutrophils which help fight infection).
While not a limitation of this study, it is important to note that among the 484 patients randomized to receive niraparib, just over 18% discontinued niraparib due to adverse events (58) or for other reasons (31). Among the 244 patients randomized to receive a placebo, a little over 5% discontinued the trial due to adverse events (5) or for other reasons (8). However, patient withdrawal from ovarian cancer trials is neither uncommon nor unique to this study. These patients all had advanced disease and had undergone multiple rounds of chemotherapy. Importantly, there were a total of 626 woman who remained on the trial for which there is data.
The results of this trial showed that treatment with niraparib provides longer progression-free survival than placebo for the overall patient population. Clinical benefit was not limited to the subset of patients whose tumors were HRD, however the largest benefit was seen in HRD cancers.
Share your thoughts on this XRAYS article by taking our brief survey.