PARP Inhibitors in Ovarian Cancer Treatment: Understanding Side Effects
Ovarian cancer treatment may cause side effects, so what should patients be aware of? Expert Dr. Ramez Eskander from UC San Diego Health discusses common ovarian cancer treatment side effects, management of side effects, and proactive patient advice for optimal care.
[ACT]IVATION TIP
“…make sure you’re asking appropriate questions, that you’re educated about treatment-related side effects as they relate to PARP inhibitors. And then lastly, to understand that dose interruptions or dose reductions are an expected part of treatment with really any anti-cancer directed therapy, including PARP inhibitors, with a goal to keep patients on therapy, because they’re benefiting from this treatment.”
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Transcript:
Lisa Hatfield:
Dr. Eskander, what are some common side effects of ovarian cancer treatments, particularly with long-term use of PARP inhibitors, and how can patients manage these side effects and maintain their quality of life during treatment?
Dr. Ramez Eskander:
PARP inhibitors, Lisa, are a very important part of the management of patients with advanced stage ovarian cancer. They have become a commonly used treatment in the first line we call it therapy or when patients are initially diagnosed as a maintenance treatment strategy and those PARP inhibitors can be given alone or the PARP inhibitors can be given in combination with another drug called bevacizumab (Avastin) as maintenance therapy. PARP inhibitors is a class I like to say are drugs that can be well tolerated.
One of the most important things that we face as providers is we are responsible to make sure our patients are educated. When we are able to have a conversation with a patient and educate them about potential treatment-related side effects and they feel empowered in managing those side effects, we’re able to make sure that patients can stay on treatment, tolerate, and of course, most importantly, benefit from this study-directed therapy for management of their cancer. As a class, some of the more common side effects of PARP inhibitors are fatigue. It’s actually one of the most common side effects.
We can see gastrointestinal side effects. They can be varied, but it can be constipation or diarrhea or abdominal cramping. We can also see hematologic side effects, which means impact on the blood counts. It can cause anemia, lowering the red blood cell count, lowering the white blood cell count, and in some instances, lowering the platelet count. There are rare, when I say rare in the front line, if you look across trials, less than about 1-1/2 percent of patients can develop a secondary malignancy of the bone marrow that’s called myelodysplastic syndrome or acute myeloid leukemia. Those are very uncommon, but they have been described when we use PARP inhibitors as a maintenance strategy in the front line.
So in these circumstances, again, it’s about education. It’s about making sure that you’re asking your provider, what might I experience, and how are we going to be proactive about mitigating these side effects? And I would like to emphasize that it’s okay when needed, to have a dose interruption, meaning pause the medication for a period of time, or a dose reduction, reduce the dose.
Because by doing so, we can make sure that a patient can stay on a treatment that they tolerate. And so managing these side effects is multi-pronged. It’s your clinician, your treatment team, of course, because it goes beyond the clinician who’s caring for you. It’s about understanding that an interruption in treatment may be needed, or reduction in the dose may be required, because that helps us keep patients on treatment.
Lisa Hatfield:
So if I understand correctly then, PARP inhibitors are something that a patient remains on until disease recurrence. That’s not a limited duration therapy, but it can be interrupted if needed a little bit of a break. So is that correct that it’s until disease recurrence?
Dr. Ramez Eskander:
In the front line when we’re talking about maintenance treatment strategy with PARP inhibitors, there’s actually a defined time period, but that defined time period is quite long on the order of two years. So you’re on a medication for a long period of time. Now, if you get to that two years, and thankfully there’s no evidence of cancer recurrence or active disease, you may be able to discontinue the PARP inhibitor.
The different trials had different durations of maintenance therapy. So you can imagine that there can be some fluctuation between trials two years or three years. But needless to say, it’s still a long period of time that you’re on an anti-cancer directed maintenance therapy. When you get to the end of that, however, you would be able to potentially discontinue treatment in conversation with your provider.
So here, in my opinion, the [ACT]IVATION tip is make sure you’re asking appropriate questions, that you’re educated about treatment-related side effects as they relate to PARP inhibitors. And then lastly, to understand that dose interruptions or dose reductions are an expected part of treatment with really any anti-cancer directed therapy, including PARP inhibitors, with a goal to keep patients on therapy, because they’re benefiting from this treatment.
