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

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.

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Correspondence to Domenica Lorusso.

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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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Keywords

  • Adherence
  • Clinical practice
  • Olaparib
  • Recurrent ovarian cancer
  • Toxicities
  • Transition