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Sharing real-world experiences to optimize the management of olaparib toxicities: a practical guidance from an Italian expert panel

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Abstract

Olaparib is the first poly(ADP-ribose) polymerase inhibitor approved as maintenance therapy of recurrent ovarian cancer (OC) patients with a BRCA mutation. To achieve the maximum clinical benefit, adherence to olaparib must be persistent. However, in clinical practice, this is challenged by the frequent suboptimal management of toxicities. In view of the expanding use of olaparib also in Italy, physicians must learn how to adequately and promptly manage drug toxicities not to unnecessarily interrupt or reduce the dose. The experts agreed that nausea,vomiting, anemia, and fatigue are the most frequent events experienced by OC patients on olaparib, and that these toxicities usually develop early during treatment, are mainly of grade 1–2 and transient and can be managed with simple non-pharmacological interventions. By sharing their real-world experiences, the panel prepared, for each toxicity, an algorithm organized by grade and besides the procedures indicated in the local label, included supportive care interventions based also on nutritional and lifestyle modifications and psycho-oncology consultation. Moreover, in view of the tablet entry into the Italian market, the full and reduced dosages of capsules and tablets were compared. This practical guidance is intended to be a tool to support especially less-experienced physicians in the management of these complex patients, with the aim to help preventing the worsening of patients’ conditions and the unnecessary interruption/reduction of olaparib dosage, which may jeopardize treatment efficacy.

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Acknowledgments

This editorial project was supported by AstraZeneca SpA Italy. Medical writing support and editorial assistance was provided by Clara Ricci, PhD (Edra SpA, Milan, Italy), and unconditionally funded by AstraZeneca SpA Italy.

Author information

Authors and Affiliations

  1. Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy

    Domenica Lorusso, Claudia Marchetti & Vanda Salutari

  2. Oncologia Medica, IRCCS Arcispedale S. Maria Nuova, Viale Risorgimento, 80, 42123, Reggio Emilia, Italy

    Alessandra Bologna

  3. Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Via Mariano Semmola, 53, 80131, Naples, Italy

    Sabrina Chiara Cecere & Marilena Di Napoli

  4. Dept. of Oncology, Vito Fazzi Hospital, Piazzetta Muratore, 73100, Lecce, Italy

    Elisabetta De Matteis & Graziana Ronzino

  5. Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina, 829, 95126, Catania, Italy

    Giusy Scandurra

  6. Medical Oncology Unit, S.Orsola-Malpighi Hospital, Viale Ercolani 4/2, Bologna, Italy

    Claudio Zamagni

  7. U.O. Oncologia, Ospedale Infermi Rimini, AUSL Romagna, viale Settembrini 2, 47923, Rimini, Italy

    Valentina Arcangeli

  8. Oncology Dept., Carpi and Mirandola Hospitals, Via G. Molinari 2, 41012, Carpi, Italy

    Fabrizio Artioli

  9. Medical Oncology Unit, University Hospital of Parma, Viale Antonio Gramsci, 14, 43126, Parma, Italy

    Mariangela Bella

  10. Oncology Unit, Ist. Oncologico del Mediterraneo, Via Penninazzo, 7, Viagrande, 95029, Catania, Italy

    Giusi Blanco

  11. Dept. of Clinical and Surgical Medicine, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy

    Cinzia Cardalesi & Rossella Lauria

  12. Medical Oncology Unit, Ospedale Valduce, Via Dante Alighieri, 11, 22100, Como, Italy

    Clelia Casartelli

  13. Medical Oncology Unit, AULSS 8 Vicenza, viale Rodolfi, 37, 36100, Vicenza, Italy

    Rocco De Vivo

  14. Dept of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Via del Ponte, 19, 21100, Varese, Italy

    Emanuele Baldo Gisone

  15. Dept of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy

    Alberto Andrea Lissoni

  16. Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy

    Alberto Andrea Lissoni

  17. Dept of Biomedical Sciences and Medical Oncology, University of Bari “Aldo Moro”, Piazza Umberto I 1, 70124, Bari, Italy

    Vera Loizzi

  18. Clinica Oncologica, AOU Ospedali Riuniti Ancona, via Conca 71, , 60020, Ancona, AN, Italy

    Elena Maccaroni

  19. Obstetrics and Gynecology, San Raffaele Hospital, Via Olgettina Milano, 60, 20132, Milan, Italy

    Giorgia Mangili

  20. Breast Unit, Ospedale S.M. Annunziata, USL Toscana Centro, Via dell’Antella, 58, Bagno a Ripoli, 50012, Florence, Italy

    Francesca Martella

  21. Division of Medical Oncology, IRCCS Istituto Oncologico Giovanni Paolo II, Viale Orazio Flacco, 65, 70124, Bari, Italy

    Emanuele Naglieri

  22. Breast Uni, Azienda Ospedaliera Universitaria Integrata, Piazzale Aristide Stefani, 1, 37126, Verona, Italy

    Veronica Parolin

  23. Medical Oncology, AO Papardo, Contrada Papardo, 98158, Messina, Italy

    Giusy Ricciardi

  24. Dept of Obstetrics, Gynecology and Neonatology, IRCCS Fondazione Cà Granda, Ospedale Maggiore Policlinico, via F. Sforza 28, Milan, Italy

    Giovanna Scarfone

  25. Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy

    Simona Secondino

  26. Medical Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Viale Principe di Napoli, 14/A, 82100, Benevento, Italy

    Ilaria Spagnoletti

  27. Division of Medical Oncology 2, Istituto Oncologico Veneto, Via Gattamelata, 64, 35128, Padua, Italy

    Giulia Tasca & Valentina Guarneri

  28. UO Ostetricia e Ginecologia-ASST degli Spedali Civili di Brescia, Università degli Studi, Piazzale Spedali Civili 1, 25123, Brescia, Italy

    Germana Tognon

Authors
  1. Domenica Lorusso
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  2. Alessandra Bologna
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  3. Sabrina Chiara Cecere
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  4. Elisabetta De Matteis
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  30. Ilaria Spagnoletti
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  31. Giulia Tasca
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  32. Germana Tognon
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  33. Valentina Guarneri
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Corresponding author

Correspondence to Domenica Lorusso.

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Conflict of interest

DL reports grants and personal fees from Immunogen, Genmab, Pharmamar, Clovis, Tesaro and Merck; personal fees from Astra Zeneca outside the submitted work; CZ reports personal fees from Takeda, Pierre Fabre, TEVA, Istituto Gentili, Roche, EISAI, Novartis, from AstraZeneca, Pfizer, PharmaMar, Celgene, Lilly, Amgen, Tesaro and QuintilesIMS outside the submitted work; RDV reports grant from AstraZeneca and Tesaro; GM reports personal fees from AstraZeneca and Tesaro, and non-financial support from Roche; VS reports fees for advisory boards and educational meetings from AstraZeneca; GT reports fees and non-financial support from Tesaro outside the submitted work; VG reports personal fees from Edra and travel grants from Tesaro.

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Lorusso, D., Bologna, A., Cecere, S.C. et al. Sharing real-world experiences to optimize the management of olaparib toxicities: a practical guidance from an Italian expert panel. Support Care Cancer 28, 2435–2442 (2020). https://doi.org/10.1007/s00520-020-05320-4

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