Oncology Drug Reference Sheet: Rucaparib
Rucaparib (Rubraca®) has U.S. Food and Drug Administration (FDA) approval for both maintenance and treatment indications in gynecologic cancers. It originally received accelerated approval in 2016 for the treatment of deleterious, BRCA variant–associated advanced ovarian cancer that has failed two or more chemotherapies. In 2018, it was approved (https://voice.ons.org/news-and-views/fda-approves-rucaparib-for-treatment-of-recurrent-ovarian-cancer) for maintenance therapy of various gynecologic malignancies. Most recently, rucaparib received approval (https://www.fda.gov/drugs/fda-grants-accelerated-approval-rucaparib-brca-mutated-metastatic-castration-resistant-prostate) for BRCA-positive metastatic castration-resistant prostate cancer treatment after androgen-directed and chemotherapy.
Category/Class
Poly ADP ribose polymerase (PARP) inhibitor
Indication
Maintenance treatment of adult patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in a complete or partial response to platinum-based chemotherapy
Treatment of patients with BRCA variant–associated epithelial ovarian, fallopian tube, primary peritoneal, or prostate cancer who have been treated with two or more chemotherapies
Dosing
600 mg twice daily. Interval dose reductions may be necessary (https://clovisoncology.com/media/1094/rubraca-prescribing-info.pdf) based on tolerance and management of adverse events.
Administration
Give orally with or without food.
Adverse Reactions
Nausea and fatigue are the most common side effects in more than 70% of patients. Vomiting, anemia, dysgeusia, AST/ALT elevation, constipation, decreased appetite, diarrhea, thrombocytopenia, neutropenia, stomatitis, nasopharyngitis or upper respiratory infection, rash, abdominal pain or distension, or dyspnea occurred in 20% or more of patients. Although uncommon, rucaparib is associated (https://clovisoncology.com/media/1094/rubraca-prescribing-info.pdf) with myelodysplastic syndrome or acute myeloid leukemia secondary malignancies.
Drug-Drug and Drug-Food Interactions
Rucaparib increases the toxicity of CYP substrates. Dose adjustments of CYP substrates may be clinically indicated (https://clovisoncology.com/media/1094/rubraca-prescribing-info.pdf).
Nursing Considerations
Patients on rucaparib should have complete blood counts monitored at baseline and monthly thereafter to track significant hematologic changes. Dose reductions may be necessary (https://clovisoncology.com/media/1094/rubraca-prescribing-info.pdf) for adverse reactions.
Patient Education
- If you miss or vomit a dose, skip the dose and take the next scheduled dose.
- Rucaparib makes you more susceptible to sunburn, so use adequate sun protection.
- Do not breastfeed while taking rucaparib.
- Rucaparib can cause fetal harm, and women of childbearing potential should use contraception during treatment and for six months after the last dose.
Gero-Oncology Considerations
No major differences in safety were observed (https://clovisoncology.com/media/1094/rubraca-prescribing-info.pdf) between older and younger patients.
Safe Handling
Rucaparib is associated (https://clovisoncology.com/media/1094/rubraca-prescribing-info.pdf) with embryo-fetal toxicity. Use safe handling procedures.
Patient Assistance
Visit rubracaconnections.com or call 844-779-7707.