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PARP inhibitor MDS — SCE Medical Oncology MCQ

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ModerateGynaecological CancersPARP inhibitor MDSSCE Medical Oncology

A 55-year-old woman with relapsed ovarian cancer develops secondary myelodysplastic syndrome (MDS) after prolonged PARP inhibitor therapy. She has pancytopenia. Bone marrow shows dysplastic changes and 8% blasts. What is the initial management priority?

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Correct answer: E — Immediately and permanently discontinue the PARP inhibitor, refer urgently to haematology

Therapy-related MDS/AML is a recognised serious adverse effect of PARP inhibitors (occurring in ~1-2% across trials). It requires immediate PARP inhibitor discontinuation and urgent haematology referral. Treatment follows standard MDS/AML protocols (azacitidine, venetoclax-based regimens, or intensive chemotherapy depending on fitness). Prognosis of therapy-related MDS/AML is generally poor. All PARP inhibitor SPCs carry this warning; patients should be monitored with regular FBC.

Reference: BNF PARP inhibitor monographs; ESMO 2024 Ovarian Cancer Guidelines