Identifying barriers to prescribing PARP inhibitors, including olaparib, in advanced ovarian cancer.

Abstract

e17560 Background: Despite improvements in survival with poly (ADP-ribose) polymerase inhibitors (PARPi) as first-line maintenance (1LM) therapy in advanced ovarian cancer (AOC), research has shown suboptimal utilization. This study assessed PARPi prescribing behavior and key barriers to prescribing PARPi, including olaparib, for approved indications in AOC. Methods: A cross-sectional online survey was completed in Fall 2025 by board-certified/-eligible medical, hematologic, and gynecologic oncologists (oncs) with experience treating AOC with PARPi in the US. The survey assessed PARPi prescribing practices, influences, and beliefs. Barriers to prescribing olaparib in AOC were assessed with a Best Worst scaling (BWS) exercise; oncs were shown 12 tasks with 4 items each and asked to select the largest and smallest challenge to prescribing olaparib. Hierarchical Bayesian modeling was used to estimate BWS scores (range 0-100, higher score = larger barrier relative to the others); means and standard errors were reported. All other data were reported descriptively. Results: Analysis included 192 oncs (38 gynecologic oncs); 44% were from academic settings. Most oncs agreed there is high scientific evidence demonstrating PARPi benefits in approved AOC settings (82%), PARPi benefits outweigh risks, motivating them to prescribe PARPi (81%), and PARPi benefits are superior to non-PARPi in BRCA-mutated (BRCAm) patients (pts) (81%). Median percentage of pts they reported treating with a PARPi in 1LM was 75% BRCAm and 70% BRCA wild type/ homologous recombination deficiency positive (HRD+). Among treatment decision makers (n = 182), reasons selected for not having prescribed a PARPi in the past 6 months included pt ineligibility (49% of oncs), pt concern about side effects (46%), results of genetic testing (34%), out-of-pocket costs (33%), pt unwillingness for other reasons (28%), and prior authorization denial (27%). BWS results showed that the largest challenges to prescribing olaparib to eligible pts with AOC were managing side effects that impact quality of life and severe side effects, followed by patient adherence and complex prior authorizations (Table). Conclusions: While most oncs believe in the benefits of PARPi for treatment of AOC, barriers to prescribing PARPi are multifactorial and for many, emphasize management of side effects. Strategies to mitigate barriers should feature multiple targets. Barriers to prescribing olaparib in AOC BWS score(higher = larger barrier) Managing side effects that impact quality of life 18.5 (0.6) Severe side effects 18.3 (0.7) Patient adherence 11.7 (0.5) Complex prior authorization process 11.3 (0.6) Potential detriment outweighs the benefit 10.6 (0.4) Other PARPi have a more favorable side effect profile 8.3 (0.4) Patient choice 8.0 (0.5) Getting the relevant genetic testing 7.6 (0.5) Other manufacturer provides better financial assistance 5.7 (0.3)