Management of Adverse Events
Recommendation 5.0 Anemia:
a. Patients requiring a blood transfusion for symptom relief and/or
hemoglobin below 8 g/dl should be monitored. PARPi dose should
be reduced with evidence of repeat anemia in order to avoid multiple
transfusions.
b. Patients with progressive anemia may be offered growth factor per
ASCO guidelines and physician and patient comfort. (Moderate
recommendation; IC-B-Ins)
Recommendation 5.1 Neutropenia:
a. Growth factor is NOT indicated for use in patients receiving daily
PARPi.
b. Neutropenia (grade 4 lasting at least 5–7 days or associated with
fever) should result in dose hold until recovery of infection and
granulocyte count, followed by dose reduction. Growth factor support
may be used in this setting to support patient safety during the drug
hold. (Moderate recommendation; IC-B-Ins)
Recommendation 5.2 Platelets:
a. Thrombocytopenia is most common with niraparib. Niraparib dosing
guidelines should be used to lower starting dose (200 mg) based on
weight and platelet count.
b. Discontinue PARPi for persistent thrombocytopenia or significant
bleeding despite dose reduction. (Moderate recommendation; IC-B-
Ins)
Recommendation 5.3 Persistent Cytopenia:
a. Evaluation for treatment-related myelodysplastic syndromes and
acute myeloid leukemia (MDS/AML) should be initiated in patients
with persistent cytopenia that occurs despite drug hold. (Moderate
recommendation; IC-B-Ins)
Recommendation 5.4 Nausea:
a. Many patients will have tachyphylaxis of nausea symptoms over the
first cycle of therapy.
b. Persistent nausea requiring daily antiemetic intervention, causing
a reduction in performance status, and/or resulting in more than
a 5% weight loss should result in dose reduction. (Moderate
recommendation; IC-B-Ins)
