Patient has received prior PARP inhibitor (olaparib, niraparib, rucaparib, talazoparib) —...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-PRIOR-PARPI-EXPOSED`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	None declared
Sources	`SRC-ARIEL3-COLEMAN-2017` `SRC-NCCN-OVARIAN-2025`

Red Flag Origin

Definition	Patient has received prior PARP inhibitor (olaparib, niraparib, rucaparib, talazoparib) — either as maintenance or for treatment of HRD/BRCA-mutant disease. PARPi-exposure influences subsequent line: reduces benefit of platinum rechallenge, alters ADC selection (mirvetuximab in ovarian), and is increasingly a stratification variable in trial design.
Clinical direction	investigate
Category	prior-therapy-class

Trigger Logic

{
  "any_of": [
    {
      "finding": "prior_parpi_received",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

Direction `investigate` (not de-escalate) because PARPi-exposure does not contraindicate any specific next-line — it informs ranking. Ovarian: post-PARPi platinum-sensitive recurrence — platinum doublet remains standard but ORR drops 20-30% vs PARPi-naive (Frenel 2022, OREO study); mirvetuximab soravtansine for FRα+ resistance/maintenance candidates (MIRASOL); bevacizumab combinations retain activity. Breast BRCA: post-talazoparib/olaparib (OlympiAD/EMBRACA) PD — capecitabine, eribulin, sacituzumab govitecan (TNBC), T-DXd if HER2-low. Prostate: post-olaparib PD (PROfound) — radium-223 if bone-predominant, Lu-177- PSMA-617, cabazitaxel.

Used By

No reverse references found in the YAML corpus.