GU cancer

Olaparib PBS listed for first-line maintenance in advanced ovarian cancer

Dr Alison Davis

More women with ovarian cancer will gain access to olaparib (Lynparza) after its PBS listing is expanded to include first-line maintenance therapy from 1 November.

The PARP inhibitor has been available on the PBS since 2017 to women whose BRCA-mutated, stage 3 and 4 platinum sensitive ovarian cancer had relapsed.

Under an expended listing it will be available for maintenance treatment for women with advanced BRCA-mutated (germline or somatic) high grade epithelial ovarian, fallopian tube or primary peritoneal carcinoma who are in response (CR or PR) to first line platinum-based chemotherapy.

It is expected that the expanded listing – announced as part of the 2020 Budget – will enable about 300 patients per year to access olaparib, for which they would usually  pay over $140,500 per course of treatment.

Subsidy was recommended by the Pharmaceutical Benefits Advisory Committee, which was told  that trials such as SOLO1 provided evidence that olaparib prolonged PFS and time to next treatment and has “the potential to make an important difference to patients in terms of quality of life, and anticipated that it was likely to result in survival benefit.”

The committee was advised that “treatment of patients [with ovarian cancer] in the first-line setting is the only opportunity to cure patients,” and that maintenance treatment with curative intent is now the preferred approach in other areas, such as immunotherapy for melanoma.

The move was welcomed by medical oncologist Dr Alison Davis, Chair of the Australia New Zealand Gynaecological Oncology Group Research Advisory Committee, who said: “This is truly great news for our BRCA+ patients, and with the ESMO 2020 update of SOLO1 reporting 48% of women receiving olaparib were disease-free at five years we can feel confident that this will have a meaningful impact on outcomes for our patients.”

Ovarian Cancer Australia also welcomed the listing of olaparib for first-line treatment, with CEO Jane Hill noting that 70% of women with ovarian cancer are diagnosed at an advanced stage, making it difficult to treat and more likely to reoccur.

“Clinical trials have shown that if olaparib is administered earlier in the treatment process for ovarian cancer diagnosed in advanced stages, the risk of the disease worsening or death at three years is reduced by 70% among women with a BRCA1 or BRCA2 gene mutation,” she said

And around 15% of all high grade epithelial ovarian cancers will have occurred in the setting of a hereditary BRCA1 or BRCA2 gene mutation, she noted.

Currently more than 1,500 Australian women are diagnosed with ovarian cancer annually and only 46% of women surviving five years beyond diagnosis.

And although olaparib is only available on the PBS to women with the BRCA mutation, Ovarian Cancer Australia said it was hopeful that in the future more drugs will be available to all women living with ovarian cancer.

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