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Treatment Name: Olaparib (Lynparza®)

Olaparib (Lynparza®) is a Chemotherapy Regimen for Breast Cancer - metastatic

How does olaparib work?
Olaparib inhibits a family of enzymes called PARP (poly ADP ribose polymerase). When the PARP enzymes are inhibited, cell DNA is severely damaged. In breast cancer cells that have a BRCA mutation (pronounced "Bracka"), the cancer cell is unable to fix the damage and it dies. However, other healthy cells that have a normally functioning BRCA gene will able to fix the damage to the DNA and they will not be affected by olaparib. Olaparib can only be given to breast cancer patients who have proven or suspected BRCA mutations.

Goals of therapy:
Olaparib is an oral chemotherapy drug taken to shrink tumors and decrease symptoms from breast cancer but is not commonly given with the goal of cure.

Schedule

  • Usual starting dose: 300 mg oral (two 150 mg tablets) by mouth twice daily

Olaparib must be dispensed by a specialty pharmacy and is taken at home.

Treatment is continued until the drug no longer works or unacceptable side effects are experienced.

Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability.

Side Effects

In clinical studies, the most commonly reported olaparib side effects are shown here.

  • Nausea, (58%)
  • Low red blood cells [anemia], (40%)
  • Vomiting, (30%)
  • Fatigue, (29%)
  • Low white blood cells [neutropenia], (27%)
  • Diarrhea, (21%)
  • Headache, (20%)
  • Cough, (17%)
  • Decreased appetite, (16%)
  • Fever, (14%)
  • Liver injury, (9-11%)
  • Redness, swelling, and blisters on palms of hands and soles of feet, (1%)

 

On average, 6% of breast cancer patients in the study discontinued treatment due to unacceptable side effects.

Side effect videos Side Effect Videos
Nausea and VomitingNausea and VomitingAnemiaAnemiaFatigue Fatigue DiarrheaDiarrheaPainPainNeutropenic FeverNeutropenic Fever

Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before treatment and periodically during treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment then approximately every 6 to 12 weeks. Imaging may include: X-rays, magnetic resonance imaging (MRI), or computerized tomography (CT) scans.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue olaparib as planned, reduce your dose, temporarily stop treatment until the side effect goes away, or switch to a different therapy.

ChemoExperts Tips

  • A large number of patients experience nausea while taking olaparib, although the severity is usually mild. Typically, anti-nausea medications do not need to be taken prior to each olaparib dose but patients should have a prescription for an anti-nausea medication to use if needed
  • Olaparib can commonly cause low red and white blood cells, low platelets, and in very rare cases it can lead to the development of bone marrow disorders such as myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). If you are experiencing unusual bruising or bleeding, severe fatigue and shortness of breath, or frequent infections and fevers, it may be a sign of low blood counts from olaparib or a more serious bone marrow disorder
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for breast cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Olaparib (Lynparza®), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Olaparib (Lynparza®). Depending upon your income, they may be able to help cover the cost of:

  • Olaparib

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Olaparib (Lynparza®) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Olaparib (Lynparza®)

Individual Drug Label Information

Olaparib (Lynparza®)

  • Olaparib is available as an oral 100 mg or 150 mg tablet 
  • Take with or without food, and a large glass of water. Swallow whole and do not chew, crush, split, or dissolve the tablets. Taking with food may help decrease the incidence or severity of nausea
  • If you miss a dose, take the next dose at the regular scheduled time. DO NOT double the dose to make up for the missed dose
  • Store at room temperature (59°F – 86°F) in a cool, dry place
  • Dosage adjustments may be required for decreased kidney function, side effects, or if certain interacting medications are also being taken
  • May cause fetal harm if taken while pregnant. Using contraception (birth control) is recommended during therapy and for 6 months after completing therapy
  • May interact with certain blood pressure, antifungal, and seizure medications. Ask your doctor or pharmacist to review your medications for any possible drug interactions 
  • May interact with grapefruit and grapefruit juice and Seville oranges (found in marmalade) causing increased blood levels of olaparib. This could increase your risk of experiencing side effects. Avoid these foods or drinking anything containing grapefruit juice during treatment 
  • Avoid therapy with St. Johns Wort as it will decrease blood levels of olaparib. This could decrease the effectiveness
  • Development of blood disorders such as myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) while receiving olaparib have been reported rarely (roughly 2% or less)
General side effects from olaparib (Lynparza®)
  • Nausea and vomiting is common, although usually mild to moderate
  • Weakness or fatigue
  • Low red and white blood cells, and low platelets
  • Diarrhea, or in some patients, constipation
  • Various gastrointestinal side effects such as abdominal pain, heartburn, decreased appetite, and altered taste may occur
  • Bone pain or muscle pain
  • Headache
  • Rash
  • Breathing difficulty is rare, but may be serious. Tell your doctor if you have new onset shortness of breath, fever, wheezing, or cough
  • Click on the olaparib (Lynparza®) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue ConstipationConstipationPainPainAnemiaAnemia

See DailyMed package insert.

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References

Robson M, Im SA, Senkus E, et al. Olaparib for Metastatic Breast Cancer in Patients with a Germline BRCA Mutation. N Engl J Med 2017;377(6):523-533.

Created: April 25, 2018 Updated: April 25, 2018

What is Breast Cancer - metastatic?

What is Metastatic Breast Cancer?
A disease of the milk-producing glands known as lobules, milk ducts, or other cells found in the breast. Metastatic breast cancer is one that has moved from the breast to other areas of the body, which may include the brain, liver, or bone. Breast cancer is one of the most common types of cancers in women, but may rarely affect men as well. Known causes of breast cancer include genetic causes, such as the BRCA mutation, or obesity. The effectiveness of the treatment may depend upon the stage at diagnosis.

Types of metastatic breast cancer:
1. Hormone-receptor positive or negative (60 - 65% of patients)

  • Estrogen Receptor positive (ER)+ or negative (ER)-
  • Progestin Receptor positive (PR)+ or negative (PR)-

2. Hormone Epidermal growth factor Receptor-2 (HER-2) positive or negative (20 - 25% of patients)

  • HER-2 +
  • HER-2 -

3. Triple Negative (15 - 18% of patients)

  • ER- and PR- and (HER-2)-
NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What does Cure mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium

What is Specialty Pharmacy?

A pharmacy that manages the handling and services for drugs used by patients with rare or chronic diseases. This has expanded in the last several years to include very expensive drugs used to treat cancer, mainly oral cancer medications or injections that can be taken at home.