Olaparib (Lynparza) is now approved for maintenance treatment in adults with deleterious or suspected deleterious germline BRCA-mutated (gBRCAm) metastatic pancreatic adenocarcinoma whose disease has been stable on at least 16 weeks of a first-line platinum-based chemotherapy regimen. This genetically mutated form of cancer can be detected by the BRACAnalysis CDx test, which the Food and Drug Administration approved in conjunction with the drug. Olaparib was previously approved for the treatment of ovarian and breast cancer.

The efficacy of olaparib for the new indication was determined in a randomized, double-blind, placebo-controlled trial of 154 patients with gBRCAm metastatic pancreatic adenocarcinoma. Median progression-free survival and median overall survival were 7.4 months and 18.9 months, respectively, in those receiving olaparib, compared with 3.8 months and 18.1 months, respectively, in those receiving placebo.

Serious adverse effects of olaparib include risk of hematologic toxicity, including myelodysplastic syndrome or acute myeloid leukemia; pneumonitis; and embryo-fetal toxicity. Common adverse effects are nausea, fatigue, vomiting, abdominal pain, anemia, diarrhea, dizziness, neutropenia, leukopenia, influenza, respiratory tract infection, arthralgia/myalgia, dysgeusia, headache, dyspepsia, decreased appetite, constipation, stomatitis, dyspnea, and thrombocytopenia.

Because olaparib is metabolized via the cytochrome P-450 (CYP) 3A pathway, nurses should determine if the patient is also taking drugs that are strong or moderate CYP3A inhibitors, as these can increase the circulating levels of olaparib; either coadministration should be avoided or the olaparib dose should be decreased. If the patient is coprescribed strong or moderate CYP3A inducers, which can decrease olaparib concentrations, the drug should be discontinued.

Nurses should teach patients and families to monitor for weakness, fatigue, fever, weight loss, frequent infections, bruising, bleeding easily, breathlessness, and blood in urine or stool (all of which can indicate serious hematologic problems), as well as new or worsening respiratory symptoms, such as shortness of breath, fever, cough, or wheezing (which can indicate pneumonitis). Women of childbearing age should be advised to use effective contraception because of the risk of embryo-fetal toxicity.

For complete prescribing information for olaparib, go to http://www.accessdata.fda.gov/drugsatfda_docs/label/2019/208558s010lbl.pdf.