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Review
Myeloid neoplasms post PARP inhibitors for ovarian cancer
  1. Giuseppe Caruso1,2,
  2. Federica Gigli3,
  3. Gabriella Parma2,
  4. Mariateresa Lapresa2,
  5. Silvia Derio2,
  6. Innocenza Palaia1 and
  7. Nicoletta Colombo4
  1. 1Department of Maternal and Child Health and Urological Sciences, University of Rome La Sapienza, Rome, Italy
  2. 2Gynecologic Oncology Division, European Institute of Oncology, Milan, Italy
  3. 3Onco-Hematology Division, European Institute of Oncology, Milan, Italy
  4. 4Medical Gynecologic Oncology Unit, University of Milan Bicocca, European Institute of Oncology, Milan, Italy
  1. Correspondence to Dr Giuseppe Caruso, Department of Maternal and Child Health and Urological Sciences, University of Rome La Sapienza, Rome 00185, Italy; g.caruso{at}uniroma1.it

Abstract

The incidence of myeloid neoplasms following treatment with poly (ADP-ribose) polymerase inhibitors (PARPi) in patients with ovarian cancer has been gradually increasing over the last few years. The cumulative exposure to PARPi and the improved overall survival of patients with ovarian cancer may represent key underlying explanations behind such trend. Fortunately, the earlier introduction of PARPi in the frontline setting reduces the risk of developing secondary myeloid neoplasms. The etiopathogenesis is still unclear but is likely to be multifactorial. The first 2 years of PARPi exposure seem to be the critical window for the onset of myeloid neoplasms post PARPi, with persistent cytopenia recognized as an early warning sign. Despite intensive treatment strategies, the outcome remains poor. There is an unmet clinical need to learn how to minimize risk, make an early diagnosis, and manage myeloid neoplasms post PARPi. First, decision making regarding the optimal maintenance treatment should avoid a ‘PARPi-for-all’ strategy. PARPi should be used cautiously in cases of high baseline risk for myeloid neoplasms and/or patients who are less likely to have a benefit. Active surveillance, accurate differential diagnosis, and prompt hematological referral are key management pillars. This review discusses what is known on this emerging issue as well as unresolved questions.

  • Ovarian Cancer
  • Medical Oncology

https://doi.org/10.1136/ijgc-2022-004190

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    Footnotes

    • Contributors GC: Conceptualization, data curation, investigation, methodology, resources, software, validation, visualization, writing - original draft, writing - review and editing. FG, GP, ML, SD, IP: data curation, methodology, validation, visualization, writing - review and editing. NC: project administration, validation, supervision; writing - review and editing. All authors have read and agreed to the published version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests NC reports fees for advisory board membership for AstraZeneca, Clovis Oncology, Eisai, GSK, Immunogen, Mersana, MSD/Merck, Nuvation Bio, Onxerna, Pfizer, Pieris, Roche; fees as an invited speaker for AstraZeneca, Novartis, Clovis Oncology, GSK, MSD/Merck; institutional research grants from AstraZeneca, and Roche. She has also reported non-remunerated activities as a member of the ESMO Guidelines Steering Committee and chair of the Scientific Committee of ACTO (Alleanza Contro il Tumore Ovarico). All other authors declare no conflicts of interest.

    • Provenance and peer review Not commissioned; externally peer reviewed.