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Niraparib Dosing — SCE Medical Oncology MCQ

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ModerateGynaecological CancersNiraparib DosingSCE Medical Oncology

A 50-year-old woman with recurrent ovarian cancer achieves a complete response on re-challenge platinum chemotherapy. She then starts niraparib maintenance. She develops thrombocytopenia (platelets 55 × 10⁹/L) after 4 weeks. What is important about niraparib dosing?

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Reveal the answer and explanation

Correct answer: E — Niraparib has an individualised starting dose (200 mg for patients <77 kg or platelets <150,000; 300 mg for others) based on the NORA trial — dose reductions and interruptions for thrombocytopenia are common, managed by the standard dose modification algorithm

Niraparib has a weight/platelet-based individualised starting dose (NORA trial): 200 mg daily for patients <77 kg OR baseline platelets <150,000/µL; 300 mg for others. This reduces first-cycle thrombocytopenia (the most common dose-limiting toxicity) from ~34% to ~21% grade 3+. Dose modification algorithm: hold for platelets <100,000, resume at reduced dose (200 mg or 100 mg) when recovered to ≥100,000. Persistent grade 4 thrombocytopenia despite dose reduction may require discontinuation. Weekly FBC monitoring in the first month is recommended.

Reference: ESMO 2024 Ovarian Cancer; NOVA; NORA Berek et al Ann Oncol 2021; BNF Niraparib