PARPs may be crushing it in the clinic, but half of doctors are still wary: executive

Up to 50% of doctors still aren't using Zejula and its PARP rivals, Lynparza and Rubraca, in ovarian cancer maintenance, according to Tesaro CMO Marty Huber, M.D. (Tesaro)

The red-hot class of PARP inhibitors showed up at this weekend’s European Society for Medical Oncology annual meeting, posting important—and impressive—data in multiple tumor types. But despite four drugs in the class and a wealth of studies supporting them, some doctors haven’t jumped on board. 

PARP drugmakers have struggled to get some physicians comfortable using the new class, even in ovarian cancer—the disease in which the first three PARP contenders started out.

“If you step back and just look at the class, you would think that, given the multiplicity of trials and agents, if a woman had ovarian cancer and was a candidate for PARP, there would be no question,” Tesaro chief medical officer Marty Huber, M.D., said.

But that’s not the case.

“What we’re seeing is, 40%, 50% of women who are eligible for a PARP as maintenance treatment for ovarian cancer are still not receiving” it, he said.

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Why the hesitation, especially considering that AstraZeneca and Merck’s Lynparza, Tesaro’s Zejula and Clovis Oncology’s Rubraca have all put up positive phase 3 data in those patients? For some doctors, it may not really be hesitation about the drugs themselves, but habit, Huber said.

“You’re basically saying, ‘Okay you’ve finished your chemotherapy, now I want you to start on maintenance treatment.’ If you haven’t been doing that before, to change your practice to say, ‘Oh, I need to think to offer this patient maintenance’”—is a challenge, he said.

And for medical oncologists beyond the major academic centers—who may see only four or five women a year who fit that patient profile—remembering to prescribe a PARP can be an even greater feat.

“Medical oncologists are busy people, and there’s a lot of data,” Huber said.

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That puts the onus on the AstraZeneca/Merck team, Tesaro, Clovis, and now Pfizer—which joined the crowd last week with an FDA nod for Talzenna—to raise awareness and make sure it sticks. And it’s for that reason that the rivals are happy to see positive in-class data roll out, even if it’s for their competitors.

Meetings like ESMO are “good for all of us,” Huber said, adding that “the more data there is that help the medical oncology community get comfortable with using a PARP inhibitor in the appropriate setting, that’s good for all patients.”