van der Noll Ruud, Marchetti Serena, Steeghs Neeltje, Beijnen Jos H, Mergui-Roelvink Marja W J, Harms Emmy, Rehorst Harriet, Sonke Gabe S, Schellens Jan H M
Department of Clinical Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066 CX, The Netherlands.
1] Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066 CX, The Netherlands [2] Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, Utrecht 3584 CG, The Netherlands.
Br J Cancer. 2015 Jul 28;113(3):396-402. doi: 10.1038/bjc.2015.256. Epub 2015 Jul 16.
Olaparib (AZD2281), a PARP-1/2 inhibitor, has been extensively investigated in clinical trials. However, limited clinical data are available about its long-term safety and anti-tumour activity.
Patients had first participated in a phase I study of olaparib combined with carboplatin and/or paclitaxel. They continued with olaparib monotherapy in their best interest if they failed to tolerate the combination due to the treatment-related adverse events (TRAEs). Safety data were collected by physical examination and regular laboratory evaluations. Disease evaluations were performed by CT scan.
At data cutoff, 21 patients were included; 10 with breast, 9 with ovarian and 2 with fallopian tube cancer of whom 16 patients had a BRCA mutation (13 BRCA1; 3 BRCA2). TRAEs were mostly haematological and most prominent shortly after switching from combination to monotherapy, probably due to carry-over effects of chemotherapy. Over time, both severity and frequency of TRAEs decreased. Responses to olaparib were durable with a median treatment duration of 52 (range 7-183) weeks. In total, nine (43%) patients were still on study at data cutoff.
Continued long-term daily olaparib was found to be safe and tolerable. Encouragingly, patients who showed a favourable response on earlier combination therapy maintained this response on olaparib monotherapy.
奥拉帕利(AZD2281),一种聚腺苷酸聚合酶-1/2(PARP-1/2)抑制剂,已在临床试验中得到广泛研究。然而,关于其长期安全性和抗肿瘤活性的临床数据有限。
患者首先参与了奥拉帕利联合卡铂和/或紫杉醇的I期研究。如果他们因治疗相关不良事件(TRAEs)而无法耐受联合治疗,则根据其最大利益继续接受奥拉帕利单药治疗。通过体格检查和定期实验室评估收集安全性数据。通过CT扫描进行疾病评估。
在数据截止时,纳入了21名患者;其中10例为乳腺癌,9例为卵巢癌,2例为输卵管癌,其中16例患者存在BRCA突变(13例BRCA1;3例BRCA2)。TRAEs大多为血液学方面的,在从联合治疗转为单药治疗后不久最为突出,这可能是由于化疗的残留效应。随着时间的推移,TRAEs的严重程度和频率均有所下降。对奥拉帕利的反应持久,中位治疗持续时间为52(范围7-183)周。在数据截止时,共有9名(43%)患者仍在研究中。
长期持续每日服用奥拉帕利被发现是安全且可耐受的。令人鼓舞的是,那些在早期联合治疗中显示出良好反应的患者在奥拉帕利单药治疗中维持了这种反应。