Therapeutic advances in medical oncology · 2025
Prevention and management of PARP inhibitor-related haematological toxicities in prostate cancer: French expert opinion using the Delphi method.
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Cassuto Ophélie, Mathieu Romain, Helissey Carole, Schmitt Antonin, Gobert Aurélien, Mourey Loïc, Jovenin Nicolas, Bouteleux Clara, Joly Florence
Аннотация
BACKGROUND: Haematological toxicities (anaemia, neutropenia and thrombocytopenia), a known class effect of poly-ADP ribose polymerase inhibitors (PARPi) may limit exposure to PARPi and therefore impact efficacy.
OBJECTIVE: This study aimed to provide practical and detailed recommendations for the prevention and management of these toxicities in metastatic prostate cancer in the real world.
DESIGN: A national consensus study was performed using a modified Delphi methodology.
METHODS: A multidisciplinary steering committee of 9 French experts formulated and submitted 38 statements to the vote of 33 French healthcare professionals experienced in oncology and PARPi in prostate and/or breast/ovarian cancers.
RESULTS: All recommendations achieved a consensus. Before initiating PARPi, haematological disorders should be investigated and appropriate corrective measures implemented. The haemoglobin level should ideally be ⩾10 g/dl and a minimum delay of 4 weeks should be respected after chemotherapy. Monitoring should be frequent for the first 3 months of treatment, at least every 15 days, and even more frequent in patients at high-risk of toxicity. In the event of symptomatic grade 2 or 3 anaemia, grade 2 or 3 thrombocytopenia and grade 3 neutropenia, PARPi treatment should be discontinued until return to grade 1. Transfusion may be considered in symptomatic grade 2 or 3 anaemia. Myelodysplastic syndrome/acute myeloid leukaemia should be suspected in cases of cytopenia persisting beyond 4 weeks or changes in the blood count after maintenance of an optimal therapeutic dose over the long term.
CONCLUSION: These proposals complement existing recommendations to guide healthcare professionals in real-world practice, and so optimise metastatic prostate cancer patient's ability to maximally benefit from PARPi.
OBJECTIVE: This study aimed to provide practical and detailed recommendations for the prevention and management of these toxicities in metastatic prostate cancer in the real world.
DESIGN: A national consensus study was performed using a modified Delphi methodology.
METHODS: A multidisciplinary steering committee of 9 French experts formulated and submitted 38 statements to the vote of 33 French healthcare professionals experienced in oncology and PARPi in prostate and/or breast/ovarian cancers.
RESULTS: All recommendations achieved a consensus. Before initiating PARPi, haematological disorders should be investigated and appropriate corrective measures implemented. The haemoglobin level should ideally be ⩾10 g/dl and a minimum delay of 4 weeks should be respected after chemotherapy. Monitoring should be frequent for the first 3 months of treatment, at least every 15 days, and even more frequent in patients at high-risk of toxicity. In the event of symptomatic grade 2 or 3 anaemia, grade 2 or 3 thrombocytopenia and grade 3 neutropenia, PARPi treatment should be discontinued until return to grade 1. Transfusion may be considered in symptomatic grade 2 or 3 anaemia. Myelodysplastic syndrome/acute myeloid leukaemia should be suspected in cases of cytopenia persisting beyond 4 weeks or changes in the blood count after maintenance of an optimal therapeutic dose over the long term.
CONCLUSION: These proposals complement existing recommendations to guide healthcare professionals in real-world practice, and so optimise metastatic prostate cancer patient's ability to maximally benefit from PARPi.