Olaparib dose re‐escalation in ovarian cancer patients who experienced severe and/or uncommon adverse events: A case series

• Published in: Asia-Pacific journal of clinical oncology 2021-04, Vol.17 (S3), p.3-11
• Main Authors: Ngu, Siew‐Fei, Tse, Ka‐Yu, Chu, Mandy M. Y., Ngan, Hextan Y. S., Chan, Karen K. L.
• Format: Article
• Language: English
• Subjects: Adenosine; Adult; adverse drug event; Adverse events; Anemia; Appetite loss; Carcinoma, Ovarian Epithelial; dose–response relationship (drug); Drug-Related Side Effects and Adverse Reactions - complications; Dyspepsia; Erythema; Erythema nodosum; Female; Humans; Lymphedema; Middle Aged; Nausea; Neutropenia; olaparib; Ovarian cancer; Ovarian Neoplasms - complications; Ovarian Neoplasms - drug therapy; Patients; Phthalazines - adverse effects; Phthalazines - pharmacology; Piperazines - adverse effects; Piperazines - pharmacology; Platinum; Ribose; Thrombocytopenia; Vomiting
• ISSN: 1743-7555; 1743-7563
• DOI: 10.1111/ajco.13584

Aim Few real‐world studies have reported detailed management and dose adjustment strategies of adverse events (AEs) of ovarian cancer (OC) patients treated with the poly(adenosine diphosphate‐ribose) polymerase inhibitor olaparib. This case series aimed to describe olaparib AEs in Chinese OC patients in real‐life settings and to explore dose modification strategies. Methods We conducted a detailed examination of the clinical records of OC patients who were treated with olaparib at the Gynecologic Oncology Unit in Hong Kong from September 2015 to December 2019, including baseline characteristics, treatment outcomes, AEs, and management strategies, particularly dose modifications. Results Nineteen patients were included, with a median olaparib treatment duration of 12 (range: 3–30) months. For recurrent platinum‐sensitive cases (n = 16), the median progression‐free survival was 16.0 months (95% confidence interval: 9.5–22.5). Eighteen (95%) patients experienced AE(s) of any grade, including four (21%) who experienced grade ≥3 AE(s). The most common AEs were as follows: nonhematologic fatigue (68%), nausea (42%), vomiting (26%), decreased appetite (26%), dyspepsia (21%), dizziness (21%), anemia (37%), neutropenia (26%), and thrombocytopenia (21%). Four specific cases involving anemia, lower limb lymphedema, myeloid neoplasm, and erythema nodosum are discussed separately. Eight patients required dose interruption or reduction due to AEs, of which five patients attempted and tolerated dose re‐escalation. Conclusion In this study, most AEs were mild, but rare AEs were observed. In OC patients, olaparib AE management with dose reductions followed by re‐escalations was feasible, including for anemia.