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Contemporary Ovarian Cancer
Contemporary Care of Patients With Advanced Ovarian Cancer: Expert Answers to FAQ

Released: June 23, 2023

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Key Takeaways
  • Recommended to follow up with patients within 2 weeks after initiating PARP inhibitor to monitor progress and provide further education.
  • Communication between pharmacists and other healthcare professionals with accurate information and discussions of potential mitigation strategies are keys for managing drug shortages.

In this commentary, Sarah Hayward, PharmD, BCOP, and Amy Ly Indorf, PharmD, BCOP, answer learner questions from the program titled, “Expert Discussion on the Evolving Treatment Landscape in Ovarian Cancer: Pharmacist Considerations for Optimizing Care.”

How are you encouraging patient adherence with PARP inhibitors?

Amy Ly Indorf, PharmD, BCOP:
All patients with advanced ovarian cancer who experience a partial or complete response to frontline platinum-based chemotherapy are candidates for PARP inhibitor maintenance therapy. Trials of frontline maintenance therapy with PARP inhibitors in advanced ovarian cancer have demonstrated improved progression-free survival (PFS) when compared with placebo. When one of our patients is initiated on a PARP inhibitor, we provide an initial patient education session, which is normally provided in person or via telehealth. Our session is separate from the provider visit because it allows some space for the patient to do her own research on the medication and come prepared with additional questions. Particularly with telehealth, she can have family members participate in the session. We then follow up by telephone in 7-10 days, and then the frequency of further follow-up sessions is individualized. Our oral chemotherapy program is still being developed. Our team of physicians, advanced practice providers, and pharmacists use an algorithmized treatment map for our patients, which really helps us standardize our messaging and ensures we are addressing the laboratory monitoring and other standard approaches. 

Sarah Hayward, PharmD, BCOP:
We have similar processes to help encourage adherence. Our usual follow-up is at the 2-week point, once we know the patients start therapy, and then periodically throughout. From my standpoint, focused patient education and communication are also crucial. We want to make sure patients communicate with us about any kind of reactions they may be having with their medication. Informing patients that there are multiple approaches that can be used with adverse events such as dose reduction or changing to another PARP inhibitor helps them to realize there are alternatives. Clinically speaking, we use them somewhat interchangeably regardless of indication if a patient is intolerant of one.

How are you managing care for your patients in light of platinum drug shortages? 

Sarah Hayward, PharmD, BCOP:
Drug shortages have several potential causes including issues with manufacturing, raw material shortages, and business decisions and have the most impact on patients. Thus far, we have implemented mitigation strategies to help ensure that we have the necessary supply. As best we can, we are trying to maintain cisplatin and carboplatin for curative intent treatment but understanding that the situation is continuing to evolve. We are also doing dose rounding, by rounding down 5% and to the nearest vial size. There is a lot of communication between the infusion pharmacy and the buyer and to make sure physicians are aware. Sometimes with carboplatin, depending on patient-specific factors, in collaboration with the physician, we may consider an AUC 5 in place of AUC 6.

Amy Ly Indorf, PharmD, BCOP:
We have made similar changes in our workflow. The shortages have not yet forced us to change treatment recommendations, but we are using similar approaches to ensure we do not reach a critical level of shortage. It is expected that the shortage will last for at least several months. Clear communication with all affected healthcare professionals and patients is paramount. Several professional organizations (eg, American Society of Clinical Oncology, American Society of Health-System Pharmacists, Society of Gynecologic Oncology) have provided additional guidance for platinum-sparing strategies in gynecological cancers.

Your Thoughts?
How does your practice improve outcomes for your patients with ovarian cancer receiving PARP inhibitors? Answer the polling question and join the conversation by adding a comment in the discussion section.

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