1577P Optimizing the Management of PARP Inhibitors in Clinical Practice: Results of a DELPHI French Consensus

PARP inhibitors (PARPi) have brought considerable progress in the management of ovarian cancer and are now one of the therapeutic options for patients with breast, prostate, and pancreatic cancers. Despite the increasing number of therapeutic indications, the practical use of PARPi remains suboptimal in terms of adequate management of adverse events and adherence - both of which would maximize patient benefit. Therefore, specific recommendations are needed. A Delphi consensus was conducted to suggest statements for improved use of PARPi. A multidisciplinary steering committee of 17 experts (oncologists, nurses, pharmacist, and patient association representative) drafted statements which were submitted to the independent and anonymous vote of clinicians and health care professionals with clinical experience of PARPi (panelists). Statements were divided into the following topics: Initiation and Treatment; Management of adverse events (including hematological, gastrointestinal, insomnia, fatigue, dizziness); Specific populations and situations; Communication with the patient; Adherence. After three voting rounds of the 61 panelists, 49/52 (94%) assertions obtained a consensus. We report here 21 statements specifically related to supportive care (19/21 obtained a consensus). It includes recommendations not to use erythropoiesis-stimulating agents (ESAs) or hematopoietic granulocyte-colony stimulating factors (G-CSFs) to treat PARPi related anemia and neutropenia, given the lack of efficacy data in this setting. Symptomatic antiemetic/anti-nausea treatments can be used to relieve grade 1 gastrointestinal adverse events, while grade ≥2 gastrointestinal adverse events should be managed with treatment interruption/dose reduction. The consensus also recommends to systematically prescribe antidopaminergics when resuming PARPi treatment after interruption due to emesis. The 21 statements will be fully presented and discussed in the communication. This work is the first Delphi consensus on the practical use of PARPi. The pragmatic guidance resulting from this work should help in the management of PARPi adverse events thus improving adherence by preserving patient quality of life.