Olaparib for OC stage IV used for 7 years - stop or keep taking? Risk

I’m not familiar with Olaparib but I do like reading through research - so I went looking. It seems like there is only hard evidence for staying on olaparib for 7 years. Not that it wouldn’t still work - there’s just not much, if any research published past 7 years. That may be why your doctor doesn’t want to recommend staying on it as most docs don’t want to put their patient at risks, when the risks are unknown.

I did look up ESMO 2024 one of the most recent internationally recognized conferences on cancer that was earlier this year. There were quite a few things on olaparib - I just didn’t have time to read them all. One idea might be to do a drug holiday with the intention of going back on it. Obviously olaparib is working for you, but the long term effects can be concerning. Maybe your oncologist would know whether a drug holiday would be feasible - if it would help your body recover, but start back up before other cancer could grow. I’m sorry I can’t be more helpful - my heart goes out to you. It’s a tough decision to make.

Suggest:
Do a search for “ESMO 2024 olaparib”
when I did this it came up with more info than I can read through right now. ESMO is the European Society for Medical Oncology. I believe it is a respected group, and would have good info. Maybe has most up to date info right now.

Found in Science Direct, This is not applicable to your current issue, but maybe good info anyway:
Secondary cytoreductive surgery followed by olaparib tablets as maintenance therapy in patients with BRCA mutated recurrent ovarian cancer: A multi-center retrospective study
https://www.sciencedirect.com/science/article/abs/pii/S0748798324000027

Great info above. The reason most doctors would suggest stopping the olaparib now is that the risk of a secondary cancer is starting to be greater than the risk of OC recurrence. More options to consider: get a second opinion, consider a lower dose of olaparib, or a very slow taper off.

@stageivsurvivor has posted describing his experiences taking Rucaparib, which like Olaparib is a PARP inhibitor, and has analogous risks of AML and MDS. In a post on April 30 from this year he mentions that has been in it for 9.5 years now. He mostly posts on the Pancreatic Cancer board. He might have an opinion.

This type of research is something you may want to track - as it can only improve in the future. As computing power expands, machine learning and AGI, finding answers will be easier.
This looks like a very comprehensive project, published April 2024.

Identifying therapeutic targets for cancer among 2074 circulating proteins and risk of nine cancers
https://www.nature.com/articles/s41467-024-46834-3#Fig2

Abstract
“Circulating proteins can reveal key pathways to cancer and identify therapeutic targets for cancer prevention. We investigate 2,074 circulating proteins and risk of nine common cancers (bladder, breast, endometrium, head and neck, lung, ovary, pancreas, kidney, and malignant non-melanoma) using cis protein Mendelian randomisation and colocalization. We conduct additional analyses to identify adverse side-effects of altering risk proteins and map cancer risk proteins to drug targets. Here we find 40 proteins associated with common cancers, such as PLAUR and risk of breast cancer [odds ratio per standard deviation increment: 2.27, 1.88-2.74], and with high-mortality cancers, such as CTRB1 and pancreatic cancer [0.79, 0.73-0.85]. We also identify potential adverse effects of protein-altering interventions to reduce cancer risk, such as hypertension. Additionally, we report 18 proteins associated with cancer risk that map to existing drugs and 15 that are not currently under clinical investigation. In sum, we identify protein-cancer links that improve our understanding of cancer aetiology. We also demonstrate that the wider consequence of any protein-altering intervention on well-being and morbidity is required to interpret any utility of proteins as potential future targets for therapeutic prevention.“

This came to my inbox as a Nature Briefing: Cancer from Nature.com. You can select areas of interest to receive different briefings.

Believe me, this is not the type of research that any patient would want to track.

This is a bunch of in silico gobbledygook based on previously published Genome Wide Association Studies (GWAS), which even if it were completely true, still would not be relevant to zaneta78's question. Over the last 10 or 15 years, enormous amounts of time and effort have been put into GWAS by very smart scientists, but there is remarkably little useful to show for it. There's no reason to think that this paper is an exception.

Hi @zaneta78, I hope you saw the helpful replies from @val64 @triciaot @lathomasmd.

Zaneta, I can understand your fear of recurrence as well as fear of developing a another cancer. Neither is a welcome development.

I'm tagging fellow ovarian cancer members like @starko @pauldale4 @stparker54 @katycot @kmulawski @jodimj @janet4290 @jbickler who talk about maintenance therapy choices in this related discussion:
- - Ovarian Cancer: Should I go on Maintenance Therapy? https://connect.mayoclinic.org/discussion/maintenance-therapy/

Zaneta, has your oncologist suggested a different maintenance therapy after stopping olaparib?