2) @onc_ce is your ONLY source for serialized #accredited CE/#CME #tweetorials in #oncology. This program is supported by an educational grant from GSK plc and is intended for healthcare professionals. Accreditation statement and faculty disclosures at https://t.co/8oShcATovC.
— @onc_ce (@onc_ce) October 5, 2022
4) First – which pts with advanced epithelial #ovariancancer (EOC) should be offered #PARPi maintenance following frontline chemotherapy?
— @onc_ce (@onc_ce) October 5, 2022
a) ➕germline/somatic BRCA mutation
b) ➕homologous recombination deficiency (HRD)
c) complete or partial remission w/chemo
d) All the above
6a) Several Ph3 RCTs have shown #PARPi to be effective as maintenance therapy for pts with newly-dx FIGO StIII/IV #ovariancancer, #fallopiantube cancer or #primaryperitoneal cancer after response to frontline chemotherapy.
— @onc_ce (@onc_ce) October 5, 2022
7a) 🔑point: Mutation status matters! Studies confirm that #PARPi maintenance is most effective in patients with a known BRCA (germline or somatic) mutation and in those whose cancer has other forms of homologous recombination deficiency (#HRD). pic.twitter.com/ZZLg5oi9TD
— @onc_ce (@onc_ce) October 5, 2022
8) 3⃣PARPi are currently available for use in patients with #ovarian cancer – #olaparib, #niraparib & #rucaparib. This summary from @NCCN describes their dosing, indication and duration of use. pic.twitter.com/X1cXnSjLbI
— @onc_ce (@onc_ce) October 5, 2022
10a) Women with #ovariancancer considering use of #PARPi do so during a time of rapidly emerging new data. It is important to note that patients no longer rely solely on their clinician for information.
— @onc_ce (@onc_ce) October 5, 2022
11a) It is also important to explain the potential impact on #QoL during the initial few months of adjustment to starting #PARPi & make a plan for aggressive management of adverse events #AEs.
— @onc_ce (@onc_ce) October 5, 2022
12) The most common #AEs from #PARPi use include hematologic toxicity (#anemia, #thrombocytopenia), nausea and vomiting and fatigue. This article provides excellent recommendations on AE management: 🔓https://t.co/9hIOxlRaFj, but let’s review a few.
— @onc_ce (@onc_ce) October 5, 2022
13b) If nausea is debilitating, consideration should be given to #PARPi dose hold followed by reduction if a patient needs to take antiemetics consistently in order to tolerate their medication. pic.twitter.com/K9DrcbEjcg
— @onc_ce (@onc_ce) October 5, 2022
15) Fatigue also occurs early after beginning tx with #PARPi. For moderate to severe fatigue, a dose hold followed by dose reduction may be helpful. Patients who are experiencing fatigue should be encouraged to try to stay active and receive good nutrition/hydration.
— @onc_ce (@onc_ce) October 5, 2022
17a) In a study presented at @ASCO22, investigators reported on real world data re: tolerability among approved #PARPi in #ovariancancer.
— @onc_ce (@onc_ce) October 5, 2022
18) In addition to the mitigation strategies above – connection with other patients who have already navigated adjustment to #PARPis, through local or on-line support groups, may increase tolerability and adherence. pic.twitter.com/HJR9ivh0OO
— @onc_ce (@onc_ce) October 5, 2022
19b) options for poll in tweet 19a ☝️:
— @onc_ce (@onc_ce) October 5, 2022
a) Discontinuation of PARPi maintenance
b) Dose hold until plts >100k followed by dose reduction
c) Continuation of therapy at current dose
d) Platelet transfusion
21) Welcome back! I am @DrMMurphy & we're discussing multiple issues providers should be prepared to address when treating #OvarianCancer with #PARP_inhibitors. Meanwhile, YOU are earning 🆓CE/#CME! We all win!
— @onc_ce (@onc_ce) October 6, 2022
👌@HemOncFellows @IJGCfellows @ESGO_society @AinhoaMada
22b) The patient has developed Grade 2 hematologic toxicity to #PARPi maintenance. No need to discontinue tx but would hold, monitor CBCs weekly and restart at a lower dose when platelets >100k. No indication for plt transfusion at this level unless pt is experiencing bleeding.
— @onc_ce (@onc_ce) October 6, 2022
24) Healthcare disparities remain a significant problem in 🇺🇸. With respect to the use of #PARPi – some key health equity issues include 1) inequities in genetic testing 2) access to healthcare and 3) lack of enrollment in landmark clinical trials.
— @onc_ce (@onc_ce) October 6, 2022
25b) While approximately 34% of White women were tested, only about 22% of Black women and 24% of Hispanic women received testing. 🔓https://t.co/BKfZ1p5hWX pic.twitter.com/LPQp8BHwag
— @onc_ce (@onc_ce) October 6, 2022
25d) The study above reminds us that it is important for clinicians to offer appropriate testing to all patients and to take the time to thoroughly address patients’ questions, concerns, and/or misconceptions.
— @onc_ce (@onc_ce) October 6, 2022
26b) In addition, many pts lack access to care because of their geography & distance from appropriate tx facilities. When starting a #PARPi, it is important to closely monitor adverse effects, & this can be especially burdensome for pts with poor access to a healthcare facility.
— @onc_ce (@onc_ce) October 6, 2022
27b) Patients identified as NH-Black and Hispanic were significantly underrepresented compared to those identified as NH-White in clinical trials for ovarian cancer. (🔓https://t.co/bwYgJf16D1)
— @onc_ce (@onc_ce) October 6, 2022
27d) See 🔓https://t.co/j9qRt3hRkV pic.twitter.com/EWWmE5FBJj
— @onc_ce (@onc_ce) October 6, 2022
28b) It is particularly important to be proactive about #AE mgmt and use a shared-decision approach with pts when #PARPi therapy is being considered.
— @onc_ce (@onc_ce) October 6, 2022
30) And that's it! You just earned 0.5h 🆓CE/#CME: #physicians #nurses #NPs #PAs #pharmacists. Go to https://t.co/gUbEowApss to claim your certificate. Want to know more about #PARPi in #ovariancancer? Check out my colleague @DrMerdithGT's tweetorial at https://t.co/LVGd1Ldwql
— @onc_ce (@onc_ce) October 6, 2022
31) I am @DrMMurphy, Med GynOnc @UFmedicine, @HemeOncGators PD, & IDEA mentee of @drdonsdizon. Thank you for joining us! Now please FOLLOW US for more of the only serialized CE/#CME-accredited #tweetorials in #oncology!
— @onc_ce (@onc_ce) October 6, 2022
🔗https://t.co/3Nl35CT0jl from @academiccme