DR LOVE: Sixty-two-year-old woman, germline BRCA mutation, with recurrent disease and is getting started as third-line therapy with olaparib, third line. That’s interesting.

Anyhow, I’m not sure how that happened. But starts on 400 PO BID. Four weeks into the therapy, the patient’s hemoglobin drops from 10.5 to 8.5, no evidence of bleeding or hemolysis. What do you do, and specifically, the question about ESAs in this situation?

DR MATULONIS: Yes, good point. I think the drop to 8.5 is not unexpected. You would expect to have some blood count drops. And I think every PARP inhibitor causes myelosuppression. And it can cause a drop in neutrophil count. It can drop count in red, and platelets as well. And especially someone who’s received prior chemotherapy. So regardless of PARP inhibitor, you have to watch blood counts.

And I think in somebody who I’m concerned about when I’m starting them on a PARP inhibitor, certainly olaparib — and it’s definitely true in the niraparib studies — is that you follow counts weekly just for the first month, just to make sure that they’re okay. So for this particular lady, she drops from 10 to 8.5. She’s already low when she started. She’s a little bit lower. I think, if she’s feeling okay and she doesn’t have underlying known cardiac disease and she’s not affected, quality of life, I would keep it going.

But I would certainly counsel her that “Yes, your hemoglobin has dropped. I want you to be particularly cognizant of how you’re feeling. And, if you’re not feeling well in the next 4 weeks before I see you again, I want you to let me know. And I’ll bring you in early for another CBC check.”

DR LOVE: How about ESAs?

DR MATULONIS: I know I’m really biased. I don’t use them at all. I know people do. So, I guess you could, but I guess theoretically, and just because of the potential for an ESA to cause cancer progression, is that black-box warning on all those labels. I don’t use them at all. I would dose reduce, and then an occasional transfusion.

Treatment strategies in the management of ovarian cancer (OC)

Mechanism of action of PARP inhibitors and importance of BRCA testing

PARP inhibitors as primary treatment after multiple lines of therapy

PARP inhibitors as maintenance therapy

Tolerability of olaparib

Treatment options after olaparib failure

Differences among PARP inhibitors

Future directions in OC research