When is the Best Time to Use PARP Inhibitors for Maintenance?

The development and use of Poly(ADP-ribose) polymerase inhibitors (PARPi) in advanced ovarian cancer (OC) have been an incredible clinical breakthrough. PARPi are FDA-approved as front-line maintenance for BRCA1-/2- associated (olaparib or niraparib), homologous recombination deficient (HRD) (niraparib or olaparib with bevacizumab), and homologous recombination proficient (HRP) (niraparib) advanced-stage high-grade ovarian cancer (HGOC). Along with a third PARPi, rucaparib, they are also approved following recurrence as both maintenance and treatment. Here we advocate for PARPi as front-line maintenance for BRCA1-/2- associated (germline or somatic) and HRD tumors. We also discuss our recommendations for patients with HRP tumors.