Olaparib/Bevacizumab for Advanced Ovarian Cancer Has Good Safety Profile

A recent analysis of safety data from the PAOLA-1 study was used to develop recommendations on clinical management of key side effects with olaparib plus bevacizumab as frontline therapy for patients with advanced ovarian cancer. These recommendations were presented by Ignacio Romero of the Instituto Valenciano de Oncologia in Valencia, Spain, and colleagues, and published in the journal Frontiers in Oncology.

In this treatment setting, maintenance therapy including olaparib given with bevacizumab is associated with benefits in patients having homologous recombination deficiency (HRD)-positive tumors and a deleterious or suspected deleterious BRCA mutation and/or genomic instability. The toxicity profile of this drug combination is also considered to be manageable and without deterioration in health-related quality of life.

In addition to discussing the combination’s benefits and risks with patients, Romero and colleagues also advised to aim for early detection and management of any side effects associated with olaparib. They proposed several recommendations for addressing various adverse events with this treatment, including both hematologic and nonhematologic toxicities. 

Regarding hematologic toxicity, the authors suggested a hemogram be performed twice-per-week during the first 2 months of treatment, and then monthly. 

For anemia, investigating potential causes and monitoring iron, folic acid, and vitamin B12 levels are recommended. They suggest reducing the olaparib dose and/or blood transfusion if the patient’s hemoglobin drops below 8 g/dL. Persistent anemia (more than 4 weeks) should prompt a referral to hematology before continuing treatment.

For thrombocytopenia, management should be based on grade, and platelet transfusions are recommended in the presence of a platelet level less than 20,000/mm³. 

Among nonhematologic toxicities, Romero and colleagues provided numerous recommendations for management of conditions such as nausea and vomiting, fatigue/asthenia, arthralgia, hypertension, and proteinuria. These ranged from common analgesics for mild pain to the use of bevacizumab in certain circumstances of hypertension or proteinuria. 

The authors noted that recommendations are limited by a lack of real-world evidence regarding long-term treatment with the combination of olaparib and bevacizumab. 

“However, on the basis of the critical review of the (scant) literature and the experience of the authors, we consider that the benefits of olaparib plus bevacizumab therapy currently outweigh potential risks, and therefore, patients with BRCA mutation or genomic instability in whom bevacizumab is added to the combination with first-line chemotherapy should not be deprived of the benefit of continuing bevacizumab in maintenance with olaparib,” they wrote in their report.

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.