PT  - JOURNAL ARTICLE
AU  - Caruso, Giuseppe
AU  - Gigli, Federica
AU  - Parma, Gabriella
AU  - Lapresa, Mariateresa
AU  - Derio, Silvia
AU  - Palaia, Innocenza
AU  - Colombo, Nicoletta
TI  - Myeloid neoplasms post PARP inhibitors for ovarian cancer
AID  - 10.1136/ijgc-2022-004190
DP  - 2023 Apr 01
TA  - International Journal of Gynecologic Cancer
PG  - 598--606
VI  - 33
IP  - 4
4099  - http://ijgc.bmj.com/content/33/4/598.short
4100  - http://ijgc.bmj.com/content/33/4/598.full
SO  - Int J Gynecol Cancer2023 Apr 01; 33
AB  - 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.