Maintenance therapy - Avastin v. Niraparib

Hi Nell, I am on Avastin maintenance. I have now had 14 treatments out of the 18 which are currently allowed under the Cancer Drugs Fund. 

Regarding PARP inhibitors, my understanding is that for maintenance only olaparib is currently offered and this is only for patients who have a positive BRCA gene test. In the absence of a positive BRCA gene mutation, the PARP inhibitors such as niraparib are currently reserved for 2nd line treatment. 

Hi MaldivesFan, 

Thanks for your reply.  I had a CT scan which showed no sign of residual disease and I was then offered either Avastin or Niraparib as maintenance treatment. I tested negative for the normal BRCA mutation but I do have a BRCA wildtype mutation. The specialists did not think that one treatment offered any more benefit for me at this stage and therefore favoured Avastin as I have already responded well to this earlier in my treatment and not suffered any significant ill effects.  This also means that Niraparib can be considered as second line treatment if necessary whereas Avastin would not be.

So, Avastin it is then!  Do you know if the 18 treatments is a total maximum?  I have already had four with my first four chemo cycles so maybe I will only receive 14 as maintenance.

Best wishes, Nell xxx

Hi Nell, I just checked and the Cancer Drugs Fund still says you can have a maximum of 18 cycles of Avastin.

I'm not sure I understand your BRCA1 & BRCA2 gene results as "wild type" is also normal (no mutation). I'd be interested to know how niraparib can be offered as first line maintenance in the absence of a BRCA gene mutation. It's olaparib that is offered for maintenance if a germline or somatic mutation is found in the BRCA1 or BRCA2 gene.

Hi Maldivesfan, I don’t know but that is definitely what I was offered as a option for maintenance treatment as it was felt that it would benefit my particular case. I’m not an expert, only reporting what three different oncologists have said to me. If this is a new option being considered in response to very recent research then good!