Cassuto Ophélie, Mathieu Romain, Helissey Carole, Schmitt Antonin, Gobert Aurélien, Mourey Loïc, Jovenin Nicolas, Bouteleux Clara, Joly Florence
Medical Oncology and Haematology Department, Polyclinique Saint George, Nice, France.
Urology Department, Centre Hospitalier Universitaire de Rennes, Rennes, France.
Ther Adv Med Oncol. 2025 Sep 13;17:17588359251367308. doi: 10.1177/17588359251367308. eCollection 2025.
Haematological toxicities (anaemia, neutropenia and thrombocytopenia), a known class effect of poly-ADP ribose polymerase inhibitors (PARPi) may limit exposure to PARPi and therefore impact efficacy.
This study aimed to provide practical and detailed recommendations for the prevention and management of these toxicities in metastatic prostate cancer in the real world.
A national consensus study was performed using a modified Delphi methodology.
A multidisciplinary steering committee of 9 French experts formulated and submitted 38 statements to the vote of 33 French healthcare professionals experienced in oncology and PARPi in prostate and/or breast/ovarian cancers.
All recommendations achieved a consensus. Before initiating PARPi, haematological disorders should be investigated and appropriate corrective measures implemented. The haemoglobin level should ideally be ⩾10 g/dl and a minimum delay of 4 weeks should be respected after chemotherapy. Monitoring should be frequent for the first 3 months of treatment, at least every 15 days, and even more frequent in patients at high-risk of toxicity. In the event of symptomatic grade 2 or 3 anaemia, grade 2 or 3 thrombocytopenia and grade 3 neutropenia, PARPi treatment should be discontinued until return to grade 1. Transfusion may be considered in symptomatic grade 2 or 3 anaemia. Myelodysplastic syndrome/acute myeloid leukaemia should be suspected in cases of cytopenia persisting beyond 4 weeks or changes in the blood count after maintenance of an optimal therapeutic dose over the long term.
These proposals complement existing recommendations to guide healthcare professionals in real-world practice, and so optimise metastatic prostate cancer patient's ability to maximally benefit from PARPi.
血液学毒性（贫血、中性粒细胞减少和血小板减少）是聚腺苷二磷酸核糖聚合酶抑制剂（PARPi）已知的类效应，可能会限制PARPi的暴露量，从而影响疗效。
本研究旨在为现实世界中转移性前列腺癌患者这些毒性反应的预防和管理提供实用且详细的建议。
采用改良德尔菲法进行全国性共识研究。
由9名法国专家组成的多学科指导委员会制定了38项声明，并提交给33名在前列腺癌和/或乳腺癌/卵巢癌方面有肿瘤学和PARPi经验的法国医疗专业人员进行投票。
所有建议均达成共识。在开始使用PARPi之前，应调查血液学疾病并采取适当的纠正措施。理想情况下，血红蛋白水平应≥10g/dl，化疗后应至少间隔4周。治疗的前3个月应频繁监测，至少每15天一次，毒性高危患者监测应更频繁。如果出现2级或3级症状性贫血、2级或3级血小板减少以及3级中性粒细胞减少，应停用PARPi直至恢复到1级。对于2级或3级症状性贫血可考虑输血。如果血细胞减少持续超过4周或在长期维持最佳治疗剂量后血细胞计数发生变化，应怀疑为骨髓增生异常综合征/急性髓系白血病。
这些建议补充了现有建议，以指导医疗专业人员在现实世界中的实践，从而优化转移性前列腺癌患者从PARPi中最大程度获益的能力。
