Clinical update

Ovarian cancer and Olaparib: what nurses need to know

Olaparib has won NICE approval as a first-line maintenance treatment for ovarian cancer rather than waiting after further rounds of chemotherapy

Olaparib has won NICE approval as a first-line maintenance treatment for ovarian cancer rather than waiting after further rounds of chemotherapy.

 Astra Zeneca
Picture: Astra Zeneca

Essential information

Ovarian cancer is the sixth most common cancer in women, with about 7,500 new cases in the UK every year, says Cancer Research UK.

Almost six in ten patients are diagnosed at a late stage in England and Northern Ireland, the charity says.

More than one third of patients in England and Wales survive the disease for ten years or more, with survival rates having almost doubled in the past 40 years in the UK. Ovarian cancer kills around 4,100 women in the UK every year.

How treatment is progressing

In July, the National Institute for Health and Care Excellence (NICE) announced it had approved olaparib for use as a first-line maintenance treatment.

The drug had previously been used at a later stage to treat advanced ovarian cancer. About 700 women are expected to benefit, says NICE.

As one of a new generation of drugs known as PARP inhibitors, olaparib works by preventing cancer cells from repairing themselves, effectively crippling them.

Disease progression is delayed by an estimated three years, says NICE. Earlier use can achieve the greatest benefit in delaying recurrence, and in a small number of patients it may even have the potential to cure the disease, says NICE.

Previously, olaparib was available to a small number of women with advanced ovarian cancer and a mutation in the BRCA1 and BRCA2 genes, following a third round of chemotherapy.

The NICE announcement means it is the first PARP inhibitor available to this group of women from the first round of treatment, giving them a better chance of surviving from the outset.

Availability of olaparib is being financed by the Cancer Drugs Fund in England until 2023, while data are collected from an ongoing clinical trial. Similar announcements for Wales and Northern Ireland are expected soon.

Meanwhile the Scottish Medicines Consortium (SMC) is also considering it, with an announcement due later this year.

Implications for nurses

As olaparib is taken in tablet form, it is much less invasive than IV chemotherapy. The recommended daily dose is 600mg, given in two 150mg tablets taken twice a day.

Common side effects include breathlessness, fatigue, nausea and vomiting, diarrhoea, indigestion, loss of appetite, taste changes, headaches or dizziness, and a cough.

Nurses should encourage women to report any side effects as soon as possible.

If women ask whether olaparib can cure ovarian cancer, nurses should give clear information – while initial findings indicate that the drug can delay recurrence in many women, more time and research is needed to work out exactly how far it can extend life.

Expert comment

Picture shows Valerie Lang, a nurse adviser on a support line at charity Target Ovarian CancerValerie Lang is a nurse adviser on a support line at charity Target Ovarian Cancer

‘This is incredibly positive news. Increased access to this group of drugs is game-changing for women with ovarian cancer.

‘As olaparib is only available to women with a mutation in the BRCA1 or BRCA2 gene, this means that they will have gone through genetic testing. It’s important to remember that they may also be dealing with the consequences of this, including for other members of their family, who may be in the process of being tested, or may have already found out they are at increased risk of breast or ovarian cancer.

‘Although the vast majority of women are eligible for genetic testing, not everyone will be. The guidelines are that women diagnosed with non-mucinous ovarian cancer in the UK, irrespective of family history, should be offered genetic testing for mutations in their BRCA1 and BRCA2 genes. More than 90% of ovarian cancers diagnosed are non-mucinous.'

Lynne Pearce is a health journalist

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