5-7 days or associated with fever) should result in dose hold until recovery of infection and granulocyte count， then dose may be reduced. Growth factor support may be used in this setting to support patient safety during the drug hold.

(Type: informal consensus， benefits outweigh harms; Evidence quality: insufficient; Strength of recommendation:moderate)，

推荐5.1（中性粒细胞减少）：

a. 患者每日接受PARPi治疗，并非生长因子治疗的适应症。

b. 中性粒细胞减少症（4度持续至少5-7天或伴有发烧）应暂停用药，直到感染消失和粒细胞计数恢复，然后减少剂量。这种情况下可以用生长因子支持疗法，以确保患者在停药期间的安全。

（类型：非正式共识，利益大于坏;证据质量：不足;推荐力度：中等）。

Recommendation 5.2 Platelets:

a. Thrombocytopenia is most common with niraparib. Niraparib dosing guidelines should be used tolower starting dose (200 mg) based on weight and platelet count.

b. Discontinue PARPi for persistent thrombocytopenia or significant bleeding despite dose reduction.

(Type: informal consensus， benefits outweigh harms; Evidence quality: insufficient; Strength of recommendation: moderate).

推荐5.2（血小板）：

a. 血小板减少症在使用尼拉帕利时最为常见。参考尼拉帕利剂量调整指南，根据体重和血小板计数，起始剂量减量（200毫克）。

b. 尽管降低了剂量，但持续性血小板减少症或明显出血患者需停用PARPi。

（类型：非正式共识，利大于弊；证据质量：不足；推荐力度：中等）

Recommendation 5.3 Persistent cytopenia：

Evaluation for treatment-related MDS/AML should be initiated in patients with persistent cytopenia that occurs despite drug hold.(Type: informal consensus， benefits outweigh harms; Evidence quality: insufficient; Strength of recommendation: moderate).

推荐5.3（持续性血细胞减少）：

尽管停药后仍发生持续性血细胞减少的患者，应着手评估有无与治疗相关的骨髓增生综合征/急性骨髓性白血病。（类型：非正式共识，利大于弊；证据质量：不足；推荐力度：中等）。

Recommendation 5.4 Nausea：

a. Many patients will have tachyphylaxis of nausea symptoms over the first cycle of therapy.

b. Persistent nausea requiring daily antiemetic intervention， causing a reduction in performance status， and/or resulting in . 5% weight loss should result in dose reduction.

(Type: informal consensus， benefits outweigh harms; Evidence quality: insufficient; Strength of recommendation: moderate).

推荐5.4（恶心）：

a. 许多患者在治疗的第一个周期会发生可以快速耐受的恶心症状。

b. 持续恶心需要每日止吐干预、导致身体状态下降和/或体重下降＞5%的患者，应降低用药剂量。

（类型：非正式共识，利大于弊；证据质量：不足；推荐力度：中等）。

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参考资料：

Tew WP， Lacchetti C， Ellis A， et al. PARP Inhibitors in the Management of Ovarian Cancer: ASCO Guideline [published online ahead of print， 2020 Aug 13]. J Clin Oncol. 2020;JCO2001924. doi:10.1200/JCO.20.01924