PARP inhibitors as maintenance therapy in newly diagnosed advanced ovarian cancer: a meta-analysis.

Abstract

Up to 70% of patients with advanced ovarian cancer have a relapse after primary therapy. New agents and approaches are urgently needed to avoid or slow down this recurrence. To investigate the efficacy of PARP inhibitors (PARPis) as maintenance treatment in patients with newly diagnosed advanced ovarian cancer. PubMed, MEDLINE, EMBASE, Cochrane Library and Web of Science databases. All randomised clinical trials (RCTs) that compared PARPis with placebo as first-line maintenance therapy in ovarian cancer. Two reviewers extracted data. Pooled hazard ratio (HR) and risk ratio (RR) with 95% confidence interval (CI) were calculated. PARPis were associated with significant improvement of progression-free survival (PFS) in advanced epithelial ovarian cancer (AeOC) (HR=0.53, 95% CI0.40-0.71; P<0.0001). The benefit was not only in women with BRCA mutations (HR=0.35, 95% CI 0.29-0.42; P<0.00001) and homologous recombination deficiency (HRD) (HR=0.43, 95% CI 0.32-0.60; P<0.00001), but also in those with nonmutated BRCA (HR=0.72, 95% CI 0.63-0.82; P<0.00001) and even non-HRD (HR=0.83, 95% CI 0.70-0.99; P=0.04). PARP inhibitors are effective as maintenance therapy among patients with newly diagnosed advanced ovarian cancer after platinum-based chemotherapy, regardless of BRCA mutation or HRD status. PARPis provide a significant PFS benefit as first-line maintenance therapy in patients with newly diagnosed advanced ovarian cancer.