Sharing real-world experiences to optimize the management of olaparib toxicities: a practical guidance from an Italian expert panel

Support Care Cancer. 2020 May;28(5):2435-2442. doi: 10.1007/s00520-020-05320-4. Epub 2020 Feb 11.


Olaparib is the first poly(ADP-ribose) polymerase inhibitor approved as maintenance therapy of recurrent ovarian cancer (OC) patients with a BRCA mutation. To achieve the maximum clinical benefit, adherence to olaparib must be persistent. However, in clinical practice, this is challenged by the frequent suboptimal management of toxicities. In view of the expanding use of olaparib also in Italy, physicians must learn how to adequately and promptly manage drug toxicities not to unnecessarily interrupt or reduce the dose. The experts agreed that nausea,vomiting, anemia, and fatigue are the most frequent events experienced by OC patients on olaparib, and that these toxicities usually develop early during treatment, are mainly of grade 1-2 and transient and can be managed with simple non-pharmacological interventions. By sharing their real-world experiences, the panel prepared, for each toxicity, an algorithm organized by grade and besides the procedures indicated in the local label, included supportive care interventions based also on nutritional and lifestyle modifications and psycho-oncology consultation. Moreover, in view of the tablet entry into the Italian market, the full and reduced dosages of capsules and tablets were compared. This practical guidance is intended to be a tool to support especially less-experienced physicians in the management of these complex patients, with the aim to help preventing the worsening of patients' conditions and the unnecessary interruption/reduction of olaparib dosage, which may jeopardize treatment efficacy.

Keywords: Adherence; Clinical practice; Olaparib; Recurrent ovarian cancer; Toxicities; Transition.

MeSH terms

  • Anemia / chemically induced
  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • BRCA1 Protein / genetics
  • BRCA2 Protein / genetics
  • Fatigue / chemically induced
  • Female
  • Humans
  • Italy
  • Mutation
  • Nausea / chemically induced
  • Nausea / therapy
  • Neoplasm Recurrence, Local / drug therapy
  • Ovarian Neoplasms / drug therapy*
  • Ovarian Neoplasms / genetics
  • Phthalazines / adverse effects*
  • Phthalazines / therapeutic use
  • Piperazines / adverse effects*
  • Piperazines / therapeutic use
  • Poly(ADP-ribose) Polymerase Inhibitors / adverse effects*
  • Poly(ADP-ribose) Polymerase Inhibitors / therapeutic use
  • Vomiting / chemically induced


  • Antineoplastic Agents
  • BRCA1 Protein
  • BRCA1 protein, human
  • BRCA2 Protein
  • BRCA2 protein, human
  • Phthalazines
  • Piperazines
  • Poly(ADP-ribose) Polymerase Inhibitors
  • olaparib