Practice Pearl 1: Efficacy of PARP Inhibitors in Ovarian Cancer Treatment


Sarah Hayward, PharmD, BCOP, and Bradley J. Monk, MD, FACS, FACOG, compare the safety and efficacy among PARP inhibitors—niraparib, olaparib, and rucaparib—for ovarian cancer treatment.

Jennifer MacDonald, PharmD, BCOP: Let’s mention the 3 PARP inhibitors that we use in ovarian cancer and some of the class toxicities that we can see with those. Sarah, do you want to start with that?

Sarah Hayward, PharmD, BCOP: Absolutely. There are 3 PARP inhibitors for ovarian cancer treatment. There’s 1 more on the market for breast cancer. But for ovarian cancer, we have niraparib, olaparib, and rucaparib. There are some common adverse effects that are important to know about the class as a whole, and then some things that are specific to each of those medications. As a class effect, it’s important that patients are educated, and we know about and monitor hematologic toxicities that can exist because of this. Fatigue can be significant, diarrhea or constipation depending on the agent, and even long-term things, like the increased risk of leukemias, secondary cancers, or myelodysplastic syndromes [MDS]. Although it’s rare, it’s a big class effect.

The other thing that’s very important to note, that we’ll probably talk about a couple times throughout our discussion today, is making sure patients are well educated on what to expect. It’s important to know that a lot of these adverse effects are more common in the first couple of months, depending on what it is. We have the opportunity to either provide a patient supportive care medications or adjust doses, if necessary, to try to keep them on it and get them through those first couple of months so we can have better longevity in their treatment.

Jennifer MacDonald, PharmD, BCOP: Dr Monk, do you have anything to add? How do you personally talk about the risk of AML [acute myeloid leukemia] and MDS with patients when you’re introducing these agents?

Bradley J. Monk, MD, FACS, FACOG: I talk about fatigue, GI [gastrointestinal], and hematological. It’s pretty simple, and just what Sarah said. AML and MDS probably aren’t increased much in frontline treatment. It’s the use in the recurrent setting, because those patients get lots of platinum and agents. The good news is that the risk of dying of ovarian cancer is way higher, so although the risk may be as low as 1% to 2% in the front line and maybe as high as 8% to 10% in the platinum-sensitive maintenance setting, the chance of dying of ovarian cancer is 80%. It’s important to be aware of it. It’s important to have a high index of suspicion, but the benefit outweighs the risks.

Sarah Hayward, PharmD, BCOP: Yes, I agree. That’s really important to communicate to patients, because as soon as they see that, it’s a very scary thing for them to know is a possibility. But letting them know that the risk is very small is very helpful.

Jennifer MacDonald, PharmD, BCOP: Yes. Depending on the PI [product information] that you look at, too, they have good rates of those risks of adverse events, whether it’s olaparib, rucaparib, or niraparib. You can look at that to see what the rates are. And now that they have more studies and have accumulated more data, I like to give patients numbers, because it helps to have actual numbers and actual risk between each of them because they’re different in some regard in those risks and things.

Transcript Edited for Clarity

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