Rucaparib for the treatment of ovarian cancer

Introduction: Poly adenosine diphosphate-ribose polymerase (PARP) inhibitors (PARPi) are evolving as one of the most promising therapies in ovarian cancers, especially for patients with a BRCA1/2 or Homologous Recombination Repair (HRR) defect. Rucaparib is one of the three PARPi approved for use in ovarian cancer. Recent research has opened an expanded indication for PARPi beyond germline BRCA1/2 (gBRCA1/2) mutation. This increases the number of patients eligible for PARPi from around 15-20% of high grade serous ovarian cancers (HGSOC) with BRCA1/2 mutations to around 50%. Areas covered: This review focuses on Rucaparib, its pharmacology and salient preclinical and clinical data. The significance of a companion diagnostic test, which helps in selection of patients for Rucaparib, the upcoming trials, future directions and challenges are also discussed. Expert opinion: In germline or somatic BRCA1/2 (g/sBRCA1/2) mutated ovarian cancer patients, Rucaparib is found to have a tolerable side effect profile and improves the progression free survival. A companion diagnostic test by Foundation Medicine's which looks at the genomic scarring, may help refine patients who would maximally benefit from Rucaparib, but is not sensitive or specific enough to categorically identify which patients will not benefit from Rucaparib. Rucaparib is an important therapeutic option for women with ovarian cancer.