Dr. Alldredge on Symptom Management in Ovarian Cancer During PARP Inhibitor Treatment

Jill Alldredge, MD, assistant professor, Ob/Gyn-Gynecologic Oncology, University of Colorado (UC) Hospital Gynecologic Oncology, UC Health Cancer Center- Highlands Ranch, Denver Health Medical Center, discusses the management of symptoms in patients with ovarian cancer during treatment with a PARP inhibitor.

A multimodal approach is needed to address the management of symptoms in patients with ovarian cancer , whether those symptoms stem from the disease, treatment with chemotherapy, or treatment with a PARP inhibitor, Alldredge says. Given that patients with ovarian cancer are already receiving daily medication, managing symptoms without administering additional medicine can be beneficial.

Symptom management outside of additional medication can include physical therapy, fitness programs, survivorship groups, support groups, massage therapy, acupuncture, and pharmacotherapeutic prophylaxis. However, there are not many data-driven approaches for hematologic recovery after PARP inhibitors; therefore, the management of energy, fatigue, and nausea can be done through multimodal strategies, Alldredge explains.

Since dose reductions are common for patients treated with PARP inhibitors, optimal treatment strategies can be developed as more experience is gained from their use, Alldredge explains. For example, starting patients at lower doses and ramping them up could allow for the mitigation of toxicity while maintaining outcomes.

New data may also shed light on alternative strategies to support hematologic recovery or affect the duration of treatment, Alldredge adds, noting additional research could show that patients may not need to receive PARP inhibitor maintenance for 2 to 3 years.

There are several maintenance strategies where the indications are under review, and the current duration of those strategies is indefinite, with patients continuing PARP inhibitor maintenance in the recurrent setting until they experienced unacceptable toxicity or disease progression, Alldredge says. Further data to guide the duration of treatment with PARP inhibitor maintenance will help improve toxicities and potentially lower the risk for patients to develop myelodysplastic syndromes, Alldredge concludes.