How to Manage The Side Effects of PARP Inhibitors — Practical Guidance

And while these game changing drugs can be well tolerated, they can have side effects. There are currently three types of PARP inhibitors approved for women with ovarian cancer, and while the dosing may vary depending on which medication a woman is on, the side effects for all three tend to be similar.

"The first month on a PARP inhibitor can be hard for patients," says Dr. Melissa Geller, gynecologic oncologist at the University of Minnesota. “Nausea is a big issue. We tell patients to let us know if they’re very nauseated, if it's become a problem, so we can give them anti-nausea medicines to take 30 minutes before taking their PARP medication. That tends to help.”

In some cases Geller says she will prescribe the PARP medication for patients to take before going to bed. "Once they go to sleep they're really not experiencing the nausea as much. So there are different ways we can play with the medication a little bit to help get rid of that nausea."

Another common complaint that Geller hears is that patients are often very fatigued. Some of that, she says, can be due to low hemoglobin levels. "We watch that very carefully. Most of our patients who are on PARP inhibitors get blood testing every month. Even if we don’t bring them in to be seen, we're still monitoring their blood levels. Occasionally, a patient may require a transfusion, though that's pretty rare."

When doctors do see counts start to drop, they might reduce the dosage of the PARP inhibitors to help alleviate the anemia and the fatigue. "Most patients see an improvement once we make that dose adjustment,” Geller says, though occasionally doctors may have to switch to a different PARP inhibitor for a patient to feel noticeably better.

"After that first month, most patients, for whatever reason, start to get used to the medication and do much better on it." The fatigue especially tends to pass, or else it’s lessened to where it’s no longer an issue.

Dr. Amanika Kumar of the Mayo Clinic who spoke to SurvivorNet, cautioned that women still need to speak with their doctor to evaluate the benefit of taking a PARP inhibitor to extend life, because there are very real side effects due to the toxicity of the drug. "Patients with HRD (homologous recombination deficiency) have a far better response than those without and those with BRCA mutations even more so. It is on us as clinicians to help patients understand the risks and benefits of treatment. Patients that have no mutation or HRD may choose not to go on maintenance (in fact I recommend they don't) because there is real toxicity to these meds."

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