Benefits and challenges of using PARP inhibitors to treat metastatic breast cancer

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Published: 8 May 2019
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Kimberly Halla - Arizona Oncology Associates PC, Scottsdale, USA

Kimberly Halla speaks to ecancer at ONS 2019 about the benefits and challenges for oncology nurses of using PARP inhibitors to treat metastatic breast cancer.

She outlines how PARP inhibitors, first used to treat ovarian cancer, have now been found to also be effective in treating metastatic breast cancer.

Kimberly also describes how beneficial PARP inhibitors are to the patient in terms of being able to take these oral therapies at home.

This programme has been supported by an unrestricted educational grant from Pfizer. 

PARP inhibitors are fantastic. The body puts together an enzyme or a protein that fixes our DNA so our body is exposed to thousands of single stranded DNA breaks all the time. PARP is an enzyme that can come in and fix those single stranded DNA breaks. But we want to block PARP in the cells of a tumour, so if we block PARP those single stranded DNA breaks then become double stranded DNA breaks. Double stranded DNA breaks when they cannot be fixed through BRCA then result in cell death or apoptosis and then eventually the cell cannot reproduce. So basic understanding is if you can’t fix DNA your cell can’t live and neither can the tumour cell.

How are PARP inhibitors being used to treat metastatic breast cancer?

Right now metastatic breast cancer we can use olaparib and we are using other ones that are coming down the line thanks to research trials. PARP inhibitors have been approved since 2014 in metastatic ovarian cancer and we have found through research they also work in not only metastatic breast cancers but they’re looking at pancreatic cancers as well. PARP inhibitors are not a benign treatment, it’s not just a pill that you take, they do have active side effects. So looking at that and looking at other solid tumours we have some great information and some great new medications for our patients, whether they are breast cancer or ovarian cancer.

How do they compare to other treatments?

In traditional settings patients are in an infusion suite and they are either there weekly or they are there every three weeks. A lot of lab abnormalities, a lot of lab assessments, compared to PARP inhibitors which is a medication, depending on the PARP inhibitor that you choose, you can take twice a day or just once a day depending on how your clinician prescribes it. What we ultimately want is quality time with family and friends so the ability to take a pill at home rather than coming into an office or a clinic or a hospital setting, that, to me, is wonderful. Giving patients time with their family and friends is exactly what we want to do.

Are there any challenges that oncology nurses face with these treatments?

Absolutely, with new treatment there are always challenges and we need to know the side effects and we need to know them well. We need to have the patients who call in understand and I think that is helpful when you set some realistic boundaries and some realistic guidelines with your patients. We need to know what anaemia is; we need to know what’s causing their anaemia; we need to know how tired they are. If the nursing can play a role in that our ultimate goal is to keep patients on medication. So if we can fix the small problems and keep our patients on medication that’s going to be the best outcome for everybody.
Educating not only nurses but clinicians and patients because patients are hearing these advertised on television, their friends and their group chats and they want to know how come I can’t be on this medication. So education for not only patients but also for the nursing staff as well helps.

What is your take home message for oncology nurses?

The take home message is listen to your patients. Our patients want to be on these medications, they want to live. The ability to offer them maintenance without being in our infusion rooms or in our offices and allowing them to continue to live their life, not only be alive but to live their life, is one of the greatest gifts we can really offer them.