PARP treatment for BRCA2-2nd gen better than Olaparib?

[HopingForTheBest1]

BRCA2 positive. Have been on Olaparib for 9 months. Great results as PSA undectable for past 7. Newer second generation PARPs now available, which could possibly be more effective? Oncologist doesn't want to change anything at this point; really can't disagree. Don't mess with success.

Another Oncologist had told me that should Olaparib eventually fail, then any other PARPs would probably not work for me. I hope he's wrong.

[GP24]

Here is an article discussing these PARP inhibitors:

ascopost.com/issues/march-2...

There is no head-to-head comparison of these drugs yet, so you cannot tell if one is better than the other. I doubt that there is a significant difference between these.

[Hidden]

Hope Olaparib continues to work for a long time. Can I just ask what dose you are on?

[HopingForTheBest1 in reply to Hidden]

4 100mg tablets 2x daily.

[Hidden in reply to HopingForTheBest1]

I think I was given half of that - so it didn’t help. Onco said at the time he’d like to give me a higher dose, but wasn’t able to at that point in time. Sounds like it might be worth a second crack. Thanks for answering and good luck.

[Tall_Allen]

The various PARP inhibitors are discussed here:

pcnrv.blogspot.com/2019/10/...

None are FDA approved for prostate cancer yet. You are getting it off-label or on a clinical trial. If you are self-funding off-label payment, there is as yet no reason to choose one over any other.

As you can see in the 6 vs 12-month results of the TRITON 2 trial of rucaparib, there is diminished effectiveness over time. However, it is possible that carboplatin will be effective in many of the men in whom a PARP inhibitor is effective.

[p3d1]

HFTB1,

That is an excellent response to a PARPi. If you look at the TRITON2 poster from ESMO 2019, on the right hand side of the waterfall chart there are only a couple of guys who achieved a 100% reduction in PSA. Most of these guys are still ongoing with treatment.

In the BRCA1/2 group, 3 men (5%) had a complete response.

I hope you are heading for that small group of complete responders.

For 7 months any faulty cells that tried to grow have died, the thing about PARPi is that it is not affecting your PSA doubling time. If your PSA was aggressive before you went on the trial then it is still doubling now. The longer you are holding an undetectable PSA then the more bad cells are being killed off.

[Hidden in reply to p3d1]

Thanks for a great explanation .