How Helpful are The Ovarian Cancer Guidelines? [Free Thoughts]
December 24, 2020
Opioids for Managing Cancer Pain
January 1, 2021
LYNPARZA is the only PARP inhibitor approved for the 4 types of advanced cancer.
“The goal of cancer treatment is to shrink the tumor and control its growth for as long as possible. This can be accomplished in a variety of ways, such as chemotherapy and targeted therapy, which is a prescription medication that works by targeting the cancer cell’s pathways.”https://www.lynparza.com/what-is-lynparza.html
Lynparza/Olaparib-Induced Nausea Ovarian Cancer:
Now that’s just one of the most common side effects that women experience with Olaparib (Lynparza), and it’s particularly bothersome because it’s present on a daily basis, as opposed to the nausea of chemotherapy, which lasts for about three or four days and then subsides.
The nausea is usually mild to moderate or less than a grade two. The nausea is usually present in the first month of therapy. Most women report it within the first two weeks, but it can be as early as day three. Vomiting is far less common and is preventable if the nausea is well controlled.
Anti-emetics
Anti-emetics, diet, good hydration, dose interruption and dose reduction are all ways to manage the nausea. When we start a patient on Olaparib, Lynparza, I counsel them proactively about the possible side effects and provide a prescription for antiemetic upfront.
I start with prochlorperazine or Metoclopramide 10 milligrams every six hours on an as-needed basis for patients who are intolerant or allergic to this class of medication, then a prescription for a serotonin agonist such as ondansetron 8 milligrams every eight hours is provided along with a bowel management plan.
Olanzapine
Olanazapine
If the nausea is not well controlled, then holding the drug for one to two days after the nausea subsides has usually has a resetting effect, and the drug can be restarted. If the nausea persists, then I recommend olanzapine 2.5 to five milligrams, once daily.
Olanzapine has the added benefit of helping with sleep when taken in the evening. Dietary measures include small frequent meals, avoiding rich or fatty foods, and hydration with at least 60 ounces of fluid per day. Olaparib (Lynparza) can be taken with or without food, but for women who experience nausea after dosing than a snack or a small meal before taking the medication is useful.
Ginger+H2 blocker
Ginger tea, ginger candy, flat ginger ale or cola helps some women, I add an H2 blocker like Famotidine, if there’s a component of indigestion along with the nausea.
Stop and re-evaluate
If the nausea is not well controlled after escalation of antiemetic or holding the drug, then a dose reduction is appropriate and usually solves the problem. The key is to have a plan in place before the medication is started and to adjust it for each individual.
NCCN guidelinesPARP inhibitorsBRCAOvarian cancerOlaparib_Patient_Education
10 Comments
I have been reading through your posts.. Really loved your content.
Do you think Olanazapine alone can cover the symptoms. Is it FDA approved for this specific use?
Another question .. about Lynparza use in breast cancer.. what is the recommended dose.? and will insurance cover it?
Hello Aurora, Thanks for your questions.
Actually Olanazapine is FDA approved for Agitation/Aggression, Bipolar disorder, Major depressive disorder and Schizophrenia.
Yet on of the off-label uses is Chemotherapy-induced acute and delayed nausea or vomiting.
Dose for that use is 5 or 10 mg on first day of chemo , then 5 or 10 mg once daily on days 2, 3 and 4 of post or during chemo.
as for the other question. It varies.. however, Lynparza general dose for BC patients is 300mg twice daily untill progression or toxicity, whatever comes first. and for the insurance part; in my own community it’s covered if the case is eligible, your oncologist must provide the correct documentation to the insurance officer.
Hope this helps.
Sorry for the delayed response.
will ginger caps works as well? I mean to decrease the nausea?
Hello Alvin, Thanks for your question.
this is from pubmed.
hope that helps.
I was using lynparza for my PC, but i wasnet able to get rid of the nausea after. I think i should tell me doctor about this olanzapine.
i wonder why he didn’t start me on this?
Some MDs choose not to go to olanzapine due to some fear of side effects. I’d suggest you speak with your doctor and explain the situation to them.
My nausea is not well managed. These medications do not control it. Granisetron does control it, but I have recently developed extreme dermatitis whenever I use it. I have already had the dose reduced. Are there other options than those listed?
Sorry for hearing that, it’s better to discuss this issue with your doctor.
However, IgE-mediated allergy to granisetron has been documented, and it requires furthers testing and investigations in your case.
Try taking the tablets for lynparza/olaparib after eating, as taking them on an empty stomach increases the symptoms of nausea.
The NCCN recommends olanzapine, lorazepam, dronabinol, haloperidol, metoclopramide, scopolamine transdermal patch, prochlorperazine or promethazine, an alternative 5-HT3 receptor antagonist such as dolasetron or granisetron, or a steroid such as dexamethasone to prevent chemotherapy induced nausea and vomiting.
Thanks so much. This is a great list to bring to my doctor for discussion! I really appreciate it.
You’re welcome.