PT  - JOURNAL ARTICLE
AU  - Ainhoa Madariaga
AU  - Valerie Bowering
AU  - Soha Ahrari
AU  - Amit M Oza
AU  - Stephanie Lheureux
TI  - Manage wisely: poly (ADP-ribose) polymerase inhibitor (PARPi) treatment and adverse events
AID  - 10.1136/ijgc-2020-001288
DP  - 2020 Jul 01
TA  - International Journal of Gynecologic Cancer
PG  - 903--915
VI  - 30
IP  - 7
4099  - http://ijgc.bmj.com/content/30/7/903.short
4100  - http://ijgc.bmj.com/content/30/7/903.full
SO  - Int J Gynecol Cancer2020 Jul 01; 30
AB  - Poly (ADP-ribose) polymerase (PARP) inhibitors (PARPi) have transformed the treatment landscape in front-line and recurrent high-grade serous ovarian cancer. Maintenance strategies with PARPi have been assessed in randomized phase III trials in ovarian cancer; switch maintenance in the case of olaparib, niraparib, and rucaparib; and concurrent followed by continuation maintenance with veliparib. These studies have shown progression-free survival advantage with PARPi maintenance, with no major adverse changes in the quality of life; however, overall survival data remain immature to date. PARPi have also been incorporated in clinical practice as a single-agent treatment strategy in high-grade serous ovarian cancer, mainly in women who harbor alterations in the BRCA1/2 genes or have alterations in the homologous recombination deficiency (HRD) pathway. Contemporary studies are looking into potentially synergistic combination strategies with anti-angiogenics and immune checkpoint inhibitors, among others. The expansion of PARPi treatment has not been limited to ovarian cancer; talazoparib is licensed in patients with HER2-negative breast cancer with germline BRCA mutations (BRCAm), and front-line olaparib maintenance in patients with pancreatic cancer with germline BRCAm. Numerous studies assessing PARPi either in monotherapy or in combination with other agents are ongoing in multiple tumors, including prostate, endometrial, brain, and gastric cancers. Many patients are being treated with PARPi, some for prolonged periods of time. As a result, a thorough knowledge of the potential short- and long-term adverse events and their management is warranted to improve patient safety, treatment efficacy, and towards maintaining an appropriate dose intensity.