Only one patient in four is still alive five years after the diagnosis of advanced ovarian cancer, i.e. which has spread outside the pelvis, whether or not it has metastasised.

The reference treatment is surgical removal, when feasible. Post surgery, cytotoxic platinum-based chemotherapy prolongs life for a short time. But when the diagnosis is made at an advanced stage, around three women out of four experience a relapse following the initial chemotherapy. When this relapse occurs after 6 months (so-called platinum-sensitive cancer), another round of platinum-based chemotherapy, possibly combined with paclitaxel, is the first-choice treatment. After this chemotherapy, there is no evidence that continuous treatment is effective.

Ovarian cancer patients having had at least two courses of chemotherapy have huge expectations, because the disease is fatal in the short term and there is no truly satisfactory treatment. Even so, the evaluation of olaparib relies on a single randomised comparative trial, which did not show any prolongation of life, including in the presence of a deleterious mutation of a BRCA gene. An ex-post analysis, by nature inconclusive, suggested a longer gap between chemotherapy courses. Above all, olaparib exposes patients in remission to frequent adverse effects similar to those of chemotherapy, some of which are fatal.

In the absence of any proven efficacy, it is better to spare patients treatment with olaparib.

©Prescrire 1 January 2017

"Olaparib (Lynparza°). Ovarian cancer: spare patients who are in remission" Prescrire Int 2017; 26 (178): 9-12. (Pdf, subscribers only).