BRCA+ Breast Cancer: Managing Patients on PARP Inhibitors
Nadine M. Tung, M.D.: Kristin, let me ask you, what has been your experience using the PARP [poly ADP ribose polymerase] inhibitors?
Kristin E. Fleischmann-Rose, NP: Our hospital has been very involved in PARP inhibitor trials. You touched on OlympiAD and OlympiA. We’ve also participated in the BROCADE trial, which looked at veliparib. And most recently, we’ve been involved in the olaparib expanded trial. We’ve primarily used olaparib, but we’ve used other PARPs and certainly are aware of the potential differences and side effects.
Nadine M. Tung, M.D.: What questions do patients typically ask you when you’re going to start them on a PARP inhibitor?
Kristin E. Fleischmann-Rose, NP: Really general questions. They want to know how effective this is, how effective it has been with other patients. They want to know how it is given, what the side effects are. We’re currently using this in patients with metastatic disease, and these patients also want to know how they will be screened while they’re receiving a PARP inhibitor. How often will I have imaging? What type of blood work will be done?
Nadine M. Tung, M.D.: So, in general, I would say that the PARP inhibitors are extremely well tolerated. It’s probably worth noting that in both the OlympiAD and the EMBRACA trial, only 5 percent of patients actually stopped their PARP inhibitor because of side effects. I think the typical patient may have very mild nausea for which we can use standard anti-nausea medications. And very often with continued use, the nausea actually gets better. There might be mild fatigue, perhaps occasional mild headache. I would say with olaparib, sometimes there can be anemia, and rarely, it is significant enough to require a transfusion.
With olaparib, there is very little lowering of the white blood cell count or the platelet count, and there’s no hair loss. With talazoparib, I would say it’s very similar, but perhaps a little bit more anemia or a lowering of the white blood cell counts or platelets. One out of four women who use talazoparib do have some mild hair thinning.
Kristin E. Fleischmann-Rose, NP: Can you discuss how we administer PARP inhibitors and how we follow patients while they’re on a PARP inhibitor?
Nadine M. Tung, M.D.: These are oral medications. They are pills. For olaparib, it’s generally two pills twice a day, for talazoparib, it’s one pill once a day. And we typically see patients once every three weeks. Patients are on the medications every day, continuously, with no breaks. And we really encourage patients to email or call us with any side effects because we do have strategies to help with any of those side effects. As we mentioned, for example, there are anti-nausea medications. Sometimes we need to lower the dose of the medication and that’s all that’s needed to help with a side effect. And so we encourage patients to call us and adhere to taking the medication, particularly for the first 90 days. And that’s really important because that’s the next time that we’re going to image or restage the cancer to see if it’s responded. So it’s really important to try to stay on it for three months so that we can see if it’s working. And for some of the side effects, interestingly, with continued use, they actually decrease.
Kristin, do you have any other thoughts about how to help patients adhere to taking their medication or strategies that might help?
Kristin E. Fleischmann-Rose, NP: Ensuring that patients know we’re always available to talk to them about side effects they might be experiencing is often the most important step to take. When patients are able to reach out to us, they can let us know what they’re experiencing. We always run it by one another. We work in a team model, including the patient and any caregivers. We discuss ways that they’ve already tried to help manage these side effects, and we brainstorm other ways that they can help manage these side effects.