Expert opinion on the management of anemia in prostate cancer patients receiving PARP inhibitors

Metastatic castration-resistant prostate cancer (mCRPC) is incurable, with tumors often relapsing after initial treatment and patients requiring subsequent lines of therapy. As the use of androgen receptor pathway inhibitors (ARPIs), with or without docetaxel, prior to the development of castration-resistant disease is increasing, the number of subsequent therapy options for mCRPC is limited.Poly (ADP-ribose) polymerase (PARP) inhibitors are one treatment option approved in Canada for patients with mCRPC and mutations in BRCA1/BRCA2 or other homologous recombination repair (HRR) genes. PARP inhibitors are generally well-tolerated but are associated with high rates of anemia. This can be difficult to manage in mCRPC, as common disease and patient characteristics, as well as prior therapy, also contribute to an increased risk of anemia. Appropriate management of anemia is important for maintaining quality of life; however, there is a paucity of data and guidelines to inform clinicians on how to best prevent and manage anemia associated with PARP inhibitor use in mCRPC.This narrative review and expert opinion provides key strategies for managing anemia related to PARP inhibitor use in mCRPC through prevention, monitoring, and supportive care.