
Ovarian cancer is one of the most lethal gynecologic cancers. The standard therapy for ovarian cancer has been the same for the past two decades, a combination treatment of platinum with paclitaxel. Recently, the FDA approved three new therapeutic drugs, two poly (ADP-ribose) polymerase inhibitors (olaparib and niraparib) and one vascular endothelial growth factor inhibitor (bevacizumab) as maintenance therapies for ovarian cancer. In this review, we summarize the resistance mechanisms for conventional platinum-based chemotherapy and for the newly FDA-approved drugs.In summary, ovarian cancers have several resistance mechanisms to PARPis. These include stimulating DNA damage response, preventing genomic instability either by upregulating Wnt signaling, inducing EHMT1/2 overexpression, or increasing ALDH1A1 levels. Alternatively, olaparib might be actively effluxed from the cells using the P-gp pump.
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