Presenting Authors: Marianne Boyer, BPharm, MSc, BCOP, and Marie-Lawrence Monfette, PharmD, MSc, BCOP, Centre hospitalier de l’Université de Montréal, Quebec, Canada
Co-Authors: Sarah Villeneuve, PharmD Candidate, and Nathalie Letarte, PharmD, MSc, DESG, BCOP, Centre hospitalier de l’Université de Montréal, Quebec, Canada
BACKGROUND: Poly (ADP-ribose) polymerase inhibitors (PARPi) significantly improve progression-free survival in ovarian cancer. However, these oral treatments have a safety profile that requires close monitoring. In a real-life setting, it is important to be aware of adverse events and their impact on treatment, such as treatment interruption, dose reduction or permanent discontinuation. Management of toxicities results in a significant burden for the treating team, including oncology nurse navigators and oncology pharmacists.
OBJECTIVE: To describe the tolerance of PARPi in a population of patients with ovarian cancer in real-life settings and the impact on the workload of oncology nurses and pharmacists.
METHODS: This is a retrospective, observational study including women with ovarian cancer treated with olaparib or niraparib as maintenance therapy between April 1, 2019, and March 31, 2022, at Centre hospitalier de l’Université de Montréal (CHUM). The primary end point was to compare the incidence of adverse events between patients treated at CHUM and phase 3 trials. The secondary end points included analyzing the incidence of dose reduction or dose interruption and the interventions performed by oncology nurses and pharmacists.
RESULTS: A total of 65 patients were included in this study, of whom 42 patients received olaparib and 23 received niraparib. Although 58% of patients required a dose reduction, 61% of them required at least 1 dose interruption. The majority of patients receiving niraparib initiated their treatment at a reduced dose of 200 mg once daily, regardless of weight, platelet count, and indication. Thrombocytopenia and fatigue were the most common hematologic and nonhematologic adverse events, leading to a dose interruption in 23% and 9% of patients, respectively. The most common adverse events leading to dose modifications were nonhematologic adverse events (41%), thrombocytopenia (15%), and anemia (14%). Oncology pharmacists and nurses provided a median of 7 (2.5-70) interventions per patient monthly, with the most frequent interventions focusing on care coordination and laboratory monitoring. The median follow-up duration of patients was 8.3 months.
CONCLUSION: Our study shows that in real-world settings, PARPi use leads to a higher frequency of dose reductions. In addition, the monitoring of patients undergoing PARPi treatment places a substantial workload on the healthcare team. As the indication for these medications continues to broaden, workload is a factor to be considered, and a thoughtful approach is necessary to optimize the management of patients on PARPi treatment.
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