With Some Adjustments Most Patients Can Tolerate Treatment
- Almost all women diagnosed with ovarian cancer are eligible to receive a PARP inhibitor at some point during their treatment.
- The most common side effects from PARP inhibitors are nausea, vomiting, and fatigue.
- Reducing the dosage can lessen side effects without impacting efficacy if needed. Up to 30% to 50% of patients will have their dose reduced at some point.
- With modifications and lifestyle adjustments, most patients can continue treatment without an impact on their quality of life.
PARP inhibitors are an emerging class of medicines that are offering new hope to patients fighting ovarian cancer, and the doctors who are treating them. The drugs work by preventing cancer cells from repairing their DNA, which can get damaged during a course of chemotherapy. Taken orally, they can help stop cancer cells from recovering and spreading.
PARP inhibitors have been available for a few years, but the pool of patients who are eligible to use them has been expanding. Now, almost all women diagnosed with ovarian cancer are eligible to receive a PARP inhibitor at some point during their treatment, though women with BRCA gene mutations or who are HRD proficient may benefit the most from these drugs.
However, the American Society of Clinical Oncology (ASCO) released new guidelines recommending PARP inhibitors be offered to women, with or without genetic mutations, who are newly diagnosed with stage III or IV ovarian cancer and have improved with chemotherapy.
There are currently three types of PARP inhibitors approved and available for ovarian cancer patents. While the dosing may vary depending on the medication, all three work in a similar way and can cause similar side effects, most commonly nausea, vomiting, and fatigue. But, says Dr. Rabbie Hanna, gynecologic oncologist with Henry Ford Health System, taking PARP inhibitors need not decrease patients’ quality of life.
“When we look at all the data regarding PARP inhibitors, what they’ve done beautifully… all the publications that we have… they’ve compared the quality of life of patients who are taking PARP inhibitors in the clinical trials to those taking a placebo.” And what we’ve seen is that they are more or less the same. “Thank God we have reached the point where we can give our patients something that is not going to make them feel miserable.”
If patients do experience side effects, says Hanna, we can make some modifications as well as suggest lifestyle changes.
For instance, “we could take a holiday from the medication, let’s say a week or two, and see how the patient feels. Then we’d go back and ‘re-challenge’ them with the same dose, or reduce the dose, to minimize their side effects.” A lower dose doesn’t make the treatment less effective, it’s just a matter of finding the dose that’s right for your body. One physician told SurvivorNet that “up to 30 to 50% of patients will require a dose reduction at some point.”
For patients experiencing nausea or vomiting, there are a number of really helpful medications available to manage that, so it’s important to let your doctor know if this becomes an issue. Some doctors may prescribe anti-nausea medicines to take 30 minutes before patients take their PARP medication. Or the PARP medication may be given before going to bed, as some people tend not to experience the nausea as much while they’re sleeping.
If the issue is fatigue we suggest that patients try to be active, and up and about as much as possible, and to take shorter, more frequent power naps rather than long naps, Hanna says. “Those break the cycle of fatigue.” Fatigue can be caused by low hemoglobin levels and doctors keep a careful eye on that. Most patients who are on PARP inhibitors will get regular blood testing to monitor their blood levels, and when doctors see counts start to drop, they’ll change the dose — reduce the dosage of the PARP inhibitors to help alleviate the anemia and the fatigue.
If insomnia is preventing a night of healthy, restful sleep, patients who are on a one-pill-per-day dose may be able to take it in the morning rather than the evening, Hanna says. “Here’s again is where we use the art of medicine and kind of play around with the drug. So far, from my personal experience with my patients, I have not had to stop somebody from a PARP inhibitor because of side effects we couldn’t manage.”
Typically many doctors say that overall, patients tolerate PARP inhibitors well enough not to stop treatment. And overall, the drugs can have a really positive effect on progression-free survival, which means the amount of time that a woman with ovarian cancer can live without their cancer getting worse.
However, Dr. Amanika Kumar of the Mayo Clinic who spoke to SurvivorNet, cautioned that women still need to speak with their doctor to evaluate the benefit of taking a PARP inhibitor to extend life, because there are very real side effects due to the toxicity of the drug. “Patients with HRD (homologous recombination deficiency) have a far better response than those without and those with BRCA mutations even more so. It is on us as clinicians to help patients understand the risks and benefits of treatment. Patients that have no mutation or HRD may choose not to go on maintenance (in fact I recommend they don’t) because there is real toxicity to these meds.”
Learn more about SurvivorNet's rigorous medical review process.
With Some Adjustments Most Patients Can Tolerate Treatment
- Almost all women diagnosed with ovarian cancer are eligible to receive a PARP inhibitor at some point during their treatment.
- The most common side effects from PARP inhibitors are nausea, vomiting, and fatigue.
- Reducing the dosage can lessen side effects without impacting efficacy if needed. Up to 30% to 50% of patients will have their dose reduced at some point.
- With modifications and lifestyle adjustments, most patients can continue treatment without an impact on their quality of life.
PARP inhibitors are an emerging class of medicines that are offering new hope to patients fighting ovarian cancer, and the doctors who are treating them. The drugs work by preventing cancer cells from repairing their DNA, which can get damaged during a course of chemotherapy. Taken orally, they can help stop cancer cells from recovering and spreading.
PARP inhibitors have been available for a few years, but the pool of patients who are eligible to use them has been expanding. Now, almost all women diagnosed with ovarian cancer are eligible to receive a PARP inhibitor at some point during their treatment, though women with BRCA gene mutations or who are HRD proficient may benefit the most from these drugs.
Read More However, the American Society of Clinical Oncology (ASCO) released
new guidelines recommending PARP inhibitors be
offered to women, with or without genetic mutations, who are newly diagnosed with stage III or IV ovarian cancer and have improved with chemotherapy.
There are currently three types of PARP inhibitors approved and available for ovarian cancer patents. While the dosing may vary depending on the medication, all three work in a similar way and can cause similar side effects, most commonly nausea, vomiting, and fatigue. But, says Dr. Rabbie Hanna, gynecologic oncologist with Henry Ford Health System, taking PARP inhibitors need not decrease patients’ quality of life.
“When we look at all the data regarding PARP inhibitors, what they’ve done beautifully… all the publications that we have… they’ve compared the quality of life of patients who are taking PARP inhibitors in the clinical trials to those taking a placebo.” And what we’ve seen is that they are more or less the same. “Thank God we have reached the point where we can give our patients something that is not going to make them feel miserable.”
If patients do experience side effects, says Hanna, we can make some modifications as well as suggest lifestyle changes.
For instance, “we could take a holiday from the medication, let’s say a week or two, and see how the patient feels. Then we’d go back and ‘re-challenge’ them with the same dose, or reduce the dose, to minimize their side effects.” A lower dose doesn’t make the treatment less effective, it’s just a matter of finding the dose that’s right for your body. One physician told SurvivorNet that “up to 30 to 50% of patients will require a dose reduction at some point.”
For patients experiencing nausea or vomiting, there are a number of really helpful medications available to manage that, so it’s important to let your doctor know if this becomes an issue. Some doctors may prescribe anti-nausea medicines to take 30 minutes before patients take their PARP medication. Or the PARP medication may be given before going to bed, as some people tend not to experience the nausea as much while they’re sleeping.
If the issue is fatigue we suggest that patients try to be active, and up and about as much as possible, and to take shorter, more frequent power naps rather than long naps, Hanna says. “Those break the cycle of fatigue.” Fatigue can be caused by low hemoglobin levels and doctors keep a careful eye on that. Most patients who are on PARP inhibitors will get regular blood testing to monitor their blood levels, and when doctors see counts start to drop, they’ll change the dose — reduce the dosage of the PARP inhibitors to help alleviate the anemia and the fatigue.
If insomnia is preventing a night of healthy, restful sleep, patients who are on a one-pill-per-day dose may be able to take it in the morning rather than the evening, Hanna says. “Here’s again is where we use the art of medicine and kind of play around with the drug. So far, from my personal experience with my patients, I have not had to stop somebody from a PARP inhibitor because of side effects we couldn’t manage.”
Typically many doctors say that overall, patients tolerate PARP inhibitors well enough not to stop treatment. And overall, the drugs can have a really positive effect on progression-free survival, which means the amount of time that a woman with ovarian cancer can live without their cancer getting worse.
However, Dr. Amanika Kumar of the Mayo Clinic who spoke to SurvivorNet, cautioned that women still need to speak with their doctor to evaluate the benefit of taking a PARP inhibitor to extend life, because there are very real side effects due to the toxicity of the drug. “Patients with HRD (homologous recombination deficiency) have a far better response than those without and those with BRCA mutations even more so. It is on us as clinicians to help patients understand the risks and benefits of treatment. Patients that have no mutation or HRD may choose not to go on maintenance (in fact I recommend they don’t) because there is real toxicity to these meds.”
Learn more about SurvivorNet's rigorous medical review process.
