Management of Niraparib Dosing in Ovarian Cancer

Amina Ahmed, MD:Forpatients in the NOVA trial, the average dose is a little over 200 mg. The starting dosage is at 300 mg of niraparib daily. The toxicity specifically with niraparib is hematologic, and even more specifically it’s thrombocytopenia. There was an exploratory analysis done of the NOVA trial, which looked at baseline weight and baseline platelets. If patients have a weight less than 77 kg or baseline platelets of less than 150,000 per m³, there should be significant consideration of dose modification. Either a patient should have their dose modified quickly from 300 mg to 200 mg, or you could even consider starting patients at 200 mg daily dosage.

For my patients who have a lower BMI [body mass index] or are less than 77 kg or who have a lower baseline platelet value—and the majority of patients already have lower platelets because they’ve been treated with platinum—I usually will start their dosage at 200 mg daily of niraparib. I typically won’t start at 300 mg, based on the exploratory analysis done on the NOVA trial.

The toxicity of niraparib specifically is hematologic. Patients who start niraparib have to have their CBCs [complete blood counts] checked weekly. If patients have significant toxicity with niraparib, specifically hematologic, a dose modification must be made. And so, based on the exploratory analysis of NOVA, the starting dose is at 300 mg. But if patients meet criteria, they may want to be started at 200 mg to avoid the significant hematologic toxicity, or as I said, prior to that they need to have their dose modification made quickly.

Transcript edited for clarity.

Case: A 56-Year-Old Female With Recurrent Ovarian Cancer

• 56-year-old female diagnosed with stage IV ovarian cancer (2016)
  • Weight: 105-lb, height: 5’6”, BMI of 16.9
  • Pathology: high-grade serous carcinoma, epithelial ovarian cancer
  • CA-125: 475 U/mL
  • CT with contrast of the pelvis, abdomen, and chest revealed a 3.5-cm mass in the right ovary and peritoneal carcinomatosis
  • Patient underwent suboptimal debulking surgery; residual disease 1.5 cm
  • Received IV/IP carboplatin/paclitaxel (6 cycles); achieved complete response
• 1 year later (2017) symptoms returned; CA-125, 265 U/mL; ECOG: 1
  • Received carboplatin/paclitaxel (6 cycles) and bevacizumab; achieved good partial response; CA-125, 45 U/mL; continued on bevacizumab maintenance
• 8 months following second-line therapy (2018), again presented with symptoms; CA-125, 550 U/mL; ECOG: 0
  • Received carboplatin/gemcitabine (6 cycles); CA-125, 54 U/mL; achieved complete response
• Currently:
  • CA-125, 585 U/mL
  • CT shows 2.7 cm right lower lobe lung mass
  • ECOG: 0