PARP inhibitors are transforming the ovarian cancer market
but standing out is a challenge
- PARP inhibitors have revolutionized ovarian cancer treatment in the recurrent setting.
Relevant Indications for PARP Inhibitors
Ovarian cancer
- Maintenance therapy for relapsed platinum-sensitive ovarian cancer regardless of BRCA status; monotherapy for germline or somatic BRCA- mutated ovarian cancer following two or more prior lines of chemotherapy.
Breast cancer
- Treatment of germline BRCA mutant patients with HER2-negative metastatic breast cancer that have been previously treated with chemotherapy in any setting.
Prostate and pancreatic cancer
- PARP inhibitors are in late-phase development for these indications.
Total 2017 US revenue for ovarian cancer: $305.5M
Estimated 2026 US revenue for ovarian, breast, prostate and pancreatic cancer: $2.2 billion
Key Current Players
AstraZeneca’s Lynparza
(olaparib)
Clovis Oncology’s Rubraca
(rucaparib)
Tesaro’s Zejula
(niraparib)
Notable Emerging Therapies
AbbVie’s veliparib
Pfizer’s talazoparib
"With three PARPs already approved for ovarian cancer and more set to enter the market, the key issue for developers will be finding ways to ensure that their PARP inhibitor stands out from the crowd.
In the absence of meaningful differences in efficacy and toxicity, non-clinical factors such as time-to-market, price and managed entry agreements will play a key role in securing market share.”
- Carolina do Pazo, Business Insights Analyst, DRG Oncology
The eventual market leader will need strong evidence or else find innovative ways to win in pricing, contracting or marketing
- Without a head-to-head comparison we don’t know which PARP inhibitor is better in terms of efficacy, particularly when they have all shown fairly good data.
Challenges Facing PARP Inhibitors
Clinical Challenges
- More mature overall survival data is needed
- Safety concerns: hematological toxicity is a common adverse event of PARP inhibitor treatment and patients may be at risk of developing a secondary hematological malignancy (e.g., MDS, AML)
Non-clinical Challenges
- Premium price and long duration treatments in the maintenance settings may increase payer enforced cost controls resulting in accessibility issues
- Use of PARP inhibitors can be limited to patients with homologous recombinational repair mutated genes
Key Points Developers Need to Address
Single-arm studies and surrogate endpoints do not fully provide the clinicians with the information necessary to make treatment decisions.
More follow-up studies for PARP inhibitors are needed as evidence of overall survival benefit ultimately has the greatest influence on physician prescribing decisions.
Indirect comparison of the PARP inhibitors based on the current evidence is difficult, so head-to-head assessments are needed.
Developers must find ways to differentiate their agent from the competition. In the absence of clinical differentiators, pricing, managed entry agreements and marketing will be crucial to optimize market uptake.
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