Outlining Emergent Toxicities in Standard Ovarian Cancer Treatment

Although many common adverse effects (AEs) related to chemotherapy use for ovarian cancer can be prevented and/or managed, neuropathy is 1 that is particularly challenging for clinicians, according to Melissa K. Frey, MD.

Frey, associate professor of Obstetrics and Gynecology in the Division of Gynecologic Oncology and director of Genetics and Personalized Cancer Prevention Program at Weill Cornell Medicine, spoke with CancerNetwork® about common toxicities that have emerged with standard therapies for ovarian cancer, including cytotoxic chemotherapies and precision-based therapies, as well as strategies to mitigate and/or prevent them.

For chemotherapeutic agents, Frey expressed that toxicities are predictable, given their decades of use for this disease. She initially touched upon several hematologic AEs, particularly cytopenias and decreases in blood cell counts, which are addressed on an individual basis, and might include transfusion, medicinal, and monitoring approaches. Additionally, nausea and vomiting, she claimed, can be remedied with pretreatment and posttreatment strategies patients can use at home.

Alopecia, a “bothersome” toxicity, may often be unpreventable, but skull cooling strategies can help prevent chemotherapy permeation into the hair follicles to mitigate hair loss. She concluded in highlighting neuropathies as unmet needs for patients with potentially lifelong consequences, and for which she expressed the field has not reached a definitive solution for.

Transcript:

Ovarian cancer is treated with combination [approaches], often of cytotoxic chemotherapies, and then also precision-based therapies like PARP inhibitors. The standard cytotoxic therapies like [platinum-based chemotherapies] and [paclitaxel] that have been used for decades in ovarian cancer and other cancers have predictable toxicities. To name a few, cytopenias or decreases in patients’ blood cell count, whether [they are] anemias or thrombocytopenias or neutropenias. Those really all must be addressed on an individual basis. Sometimes that means a transfusion for anemia. Sometimes that means medications to elevate the white blood cell count. Sometimes that means close monitoring of platelets or platelet transfusions. That is a [quite] common and shared toxicity across many chemotherapeutic agents.

Other common toxicities are nausea and vomiting. And thankfully, we have gotten better at pretreatments for some of these symptoms and posttreatments that the patients can use at home to try to alleviate some of those symptoms. Alopecia is something that is bothersome to many patients, and a difficult part of chemotherapy. And although we cannot prevent alopecia for all patients, there are models now for scalp cooling so that we can decrease the permeation of chemotherapies into the hair follicles to either decrease or prevent some of the hair loss.

An area where we still need to improve is neuropathies. And this is something that, unfortunately, is common in patients who are treated with chemotherapies, and neuropathies or that tingling sensation or pain or loss of sensation often in the fingers and toes, can happen with chemotherapy. For many patients, that can become lifelong. This is something that we are working on preventing and treating, but I do not think we are there yet.