Table 1.

PARP Inhibitor Overview

Generic (Brand)	Niraparib (Zejula)	Olaparib (Lynparza)	Rucaparib (Rubraca)
Manufacturer	Tesaro	AstraZeneca	Clovis Oncology
Cost (AWP)	100-mg capsules (90): $15,930.00 USD	50-mg capsules (112): $3,888.20 USD 100-mg tablets (60): $6,943.23 USD 150-mg tablets (120): $13,886.46 USD	200-mg tablets (60): $8,821.20 USD 250-mg tablets (60): $8,821.20 USD 300-mg tablets (60): $8,821.20 USD
FDA-Approved Indications	Maintenance treatment of recurrent ovarian cancer in patients who are in a complete or partial response to platinum-based chemotherapy	(Capsules & Tablets) Germline BRCA-mutated advanced ovarian cancer in patients who have received 3 or more lines of chemotherapy (Tablets) Maintenance treatment of adult patients with recurrent, epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in complete or partial response to platinum therapy, regardless of BRCA status	Germline and/or somatic BRCA-mutated advanced ovarian cancer in patients who have received two or more prior lines of chemotherapy
Elimination Half-Life	36 hours	Capsules: 11.9 +/− 4.8 hours Tablets: 14.9 +/− 8.2 hours	17–19 hours
Metabolism	Carboxylesterases to an inactive metabolite, which subsequently undergoes glucuronidation	Primarily hepatic: via oxidative metabolism (CYP3A4: major), minor glucuronide and sulfate conjugation	Primarily hepatic: via oxidative metabolism (CYP2D6: major) (CYP1A2/CYP3A4: minor)
Elimination	Urine (~48%) Feces (~39%)	Urine (~44%) Feces (~42%)	Not specified by manufacturer
Precautions	Hypertension and hypertensive crisis have been reported. Antihypertensives and niraparib dose adjustment may be indicated. Patients may experience bone marrow suppression, GI toxicity, and CNS fatigue. Increased risk for secondary AML/MDS (rare)	Rare cases of pneumonitis have occurred, some fatal. Major CYP3A4 substrate, provides increased potential for drug interactions Monitor for increased toxicity in patients with renal impairment. Patients may experience bone marrow suppression, GI toxicity, and CNS fatigue. Increased risk for secondary AML/MDS (rare)	High-fat meal affects drug exposure: Cmax → 20%, AUC → 38%, and Tmax delayed by 2.5 hours. Still approved to take with or without regard to food Patients may experience bone marrow suppression, GI toxicity, and CNS fatigue. Increased risk for secondary AML/MDS (rare)

AML = acute myeloid leukemia; AUC = area under the curve; AWP = average wholesale price; Cmax = maximum concentration; CNS = central nervous system; GI = gastrointestinal; MDS = myelodysplastic syndrome; Tmax = time to maximum concentration; USD = U.S. dollar. RED BOOK prices effective August 15, 2018.