Considerations in the management of select ARs

Gastrointestinal disorders

This information is not meant to replace the clinical judgment of the attending physician.

As part of your assessment and management of a potential adverse reaction, evaluate whether LYNPARZA dosing should be interrupted, reduced, or discontinued.

Nausea & vomiting

Patient counseling1

Advise patients that:

  • Mild or moderate nausea and/or vomiting are very common in patients receiving LYNPARZA
  • Management strategies exist to aid in the alleviation of the symptoms of nausea and vomiting
  • Communication with their care team may inform their experience on therapy
  • They should consult with their care team about available antiemetic treatment options
  • They should report to their healthcare provider any new or worsening symptoms they experience while taking medication

Clinical evaluation

As part of your clinical evaluation, consider potential causes, including if the patient’s cancer has progressed or recurred, and evaluate appropriately. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) recommendations for evaluation include:

Assess:

  • Determine the severity of nausea and vomiting2

Consider other potential causes of emesis in patients with cancer, including3:

  • Vestibular dysfunction
  • Brain metastasis
  • Electrolyte imbalance
  • Uremia
  • Concomitant drug treatments
  • Psychophysiologic (anxiety and anticipatory nausea and vomiting)
  • Pancreatitis

See NCCN Guidelines® for Palliative Care and NCCN Guidelines for Antiemesis for further information

NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

Management considerations

NCCN Guidelines recommendations for intervention include:

  • Appropriate prophylactic antiemetic therapy to reduce the incidence of nausea/vomiting. For more information on emetic risk of cancer therapies, including olaparib, and recommendations for antiemetic agents, see the NCCN Guidelines for Antiemesis3
  • Counsel patients on their eating habits and to adopt other lifestyle measures that may alleviate nausea and/or vomiting such as2,3:
    • Small frequent meals, choosing healthy foods, controlling the amount of food consumed, full liquid foods, and eating food at room temperature. A dietary consult may also be useful

Other management strategies include:

  • Treat dehydration, uremia, and hypercalcemia2

Consider2:

  • Psychiatric consultation
  • Acupuncture, hypnosis, and cognitive behavioral therapy

See NCCN Guidelines for Palliative Care and NCCN Guidelines for Antiemesis for further information.

NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

Diarrhea

Patient counseling1,5

Advise patients that:

  • Diarrhea is a common side effect when receiving LYNPARZA
  • Management strategies exist to aid in the alleviation of the symptoms of diarrhea
  • Communication with their care team may inform their experience on therapy
  • They should report to their healthcare provider any new or worsening symptoms they experience while taking medication

Clinical evaluation2

As part of your clinical evaluation, consider potential causes, including if the patient’s cancer has progressed or recurred, and evaluate appropriately. NCCN Guidelines recommend screening and assessment to evaluate diarrhea severity and cause.

See NCCN Guidelines for Palliative Care for further information.

NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

NCCN Guidelines recommendations for intervention include2: 

  • Provide immediate antidiarrheal therapy indicated by grade
    • May include oral hydration or IV fluids 
  • Tailor treatment to potential causes
    •  Irritable bowel syndrome (IBS) or Crohn’s disease
    •  Postsurgical or anatomic changes
    •  Recent antibiotic use 
    •  Drugs that frequently induce diarrhea
    •  Dietary changes 
    •  Infection 

Other considerations may apply depending on clinical presentation. See the NCCN Guidelines for complete information.

See NCCN Guidelines for Palliative Care for further information.

NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

Patients should talk with their healthcare team about management strategies, including5:

  • Trying the BRAT diet (bananas, rice, applesauce, and toast) when ready to eat solid foods
  • Avoiding caffeine, alcohol, high-fat foods, acidic drinks such as orange and prune juices, and spicy or sugary foods
  • Starting a clear liquid diet (water, weak tea, apple juice, peach or apricot nectar, clear broth, popsicles, or jello) when diarrhea starts or before
  • Drinking at least 1 cup of liquid (such as water, sports drinks, or bouillon) after each loose bowel movement
  • Taking medicine only if and as prescribed

Dyspepsia

Patient counseling1,6

Advise patients that:

  • Dyspepsia is a potential side effect when receiving LYNPARZA
  • Management strategies exist to aid in the alleviation of the symptoms of dyspepsia
  • Communication with their care team may inform their experience on therapy
  • They should report to their healthcare provider any new or worsening symptoms they experience while taking medication

Clinical evaluation6

As part of your clinical evaluation, consider potential causes, including if the patient’s cancer has progressed or recurred, and evaluate appropriately.

  • Complete a history and physical examination to determine possible etiologies of dyspepsia symptoms
  • Assess medication history for any drugs associated with dyspepsia

Causes of dyspepsia may include:

  • Helicobacter pylori infection
  • Acid secretion
  • Abnormal gastric or duodenal motility
  • Impaired gastric myoelectrical activity
  • Immune activation
  • Anxiety and/or depression

Management considerations6

Management considerations include:

  • Recommending the limitation of foods that may contribute to dyspepsia (eg, wheat, high-fat foods, FODMAPs, caffeine)
  • Eradication of H. pylori
  • Acid suppression

Constipation

Patient counseling1,7

Advise patients that:

  • Constipation is a potential side effect when receiving LYNPARZA
  • Management strategies exist to aid in alleviation of the symptoms of constipation
  • Communication with their care team may inform their experience on therapy
  • They should report to their healthcare provider any new or worsening symptoms they experience while taking medication

Clinical evaluation7

As part of your clinical evaluation, consider potential causes, including if the patient’s cancer has progressed or recurred, and evaluate appropriately.

Causes of constipation include:

  • Certain cancers, especially colorectal
  • Advanced cancers
  • Concomitant medications (eg, chemotherapy medicines, immunomodulatory medicines, and other medicines)
  • Lack of exercise
  • Low fluid intake and low fiber diet 
  • Overuse of laxatives

Management considerations7

  • Eating more insoluble fiber and avoiding soluble fiber
  • Use of a laxative or enema and suppositories if appropriate
  • Physical activity
  • Medicines
  • Trying pelvic therapy and biofeedback

If a patient has constipation, make sure their doctor or cancer team knows about it. Constipation can cause serious problems if it isn't managed.