Post-chemotherapy maintenance treatment by nicotinamide riboside, a poly ADP ribose polymerase 1 inhibitor, in BRCA mutated advanced ovarian cancer – A perspective

Abstract

Poly ADP ribose polymerase 1 (PARP-1) inhibitors are approved for post-chemotherapy maintenance in BRCA mutated ovarian carcinoma. Various PARP-1 inhibitors such as olaparib, rucaparib, niraparib, and veliparib are approved for this indication. These PARP-1 inhibitors are costly as well as having toxic potential, anemia, and neutropenia is the major side effects. Most of the middle-aged women in Indian subcontinent are anemic and prescription of PARP-1 inhibitors is tricky in such conditions, besides their cost is at times unaffordable as maintenance chemotherapy. Hence, we need an affordable yet lesser toxic PARP-1 inhibitor to solve this problem. Nicotinamide, a vitamin B3 amide can be re-purposed as PARP-1 inhibitor. Nicotinamide, albeit at a higher dose, can be efficacious as well as economical in its use as maintenance chemotherapy. It has toxic potential but the toxicity is both rare and manageable. We need a clinical trial for this purpose. Following perspective is on the current evidence on high dose nicotinamide and it is re-purposing as PARP-1 inhibitor.