Poly (adenosine diphosphate [ADP]-ribose) polymerase inhibitor first-line maintenance among patients with newly diagnosed advanced ovarian cancer in a real-world database (351)

Abstract

Objectives: With the advent of poly (adenosine diphosphate [ADP]- ribose) polymerase inhibitors (PARPi), first-line (1L) maintenance therapy in patients with ovarian cancer (OC) has evolved in recent years. This study described the use of 1L maintenance and assessed predictors of 1L PARPi maintenance therapy use among PARPi- eligible patients with OC in a real-world setting. Methods: This retrospective cohort study included patients with newly diagnosed stage III/IV epithelial OC who received the last dose of 1L platinum-based chemotherapy (PBC) between January 1, 2017, and February 28, 2021, from the nationwide Flatiron Health electronic health record-derived database. During the study period, the de-identified data originated from approximately 280 US cancer clinics. The end of the last cycle of 1L PBC was defined as the index date. Patients who started a second-line treatment within two months of the index date were excluded. Multivariable logistic regression was used to identify predictors of 1L PARPi monotherapy use versus active surveillance (AS). Variables included in the model were selected using the stepwise approach. Results: A total of 1010 patients were included in the study; 37.9% and 62.1% of patients received maintenance therapy and AS, respectively. A total of 162 (16.0%) patients received PARPi monotherapies (niraparib 6.3%, olaparib 8.7%, and rucaparib 1.0%), 122 (12.1%) received bevacizumab monotherapy, 33 (3.3%) received bevacizumab + PARPi combination therapies and 66 (6.5%) received other therapies. The median age was 68.0 years (Q1:58.0; Q3:75.0) for AS and 65.0 years (56.0; 71.8) for PARPi monotherapies. Other patient characteristics are shown in Table 1. Patients with BRCA mutation were significantly more likely to receive PARPi monotherapies (odds ratio [OR]: 7.49; 95% CI: 4.21-13.31) than patients with BRCA wild-type. Patients treated in 2019 (OR: 7.57; 95% CI: 3.86-14.86) and 2020 (OR: 14.99; 95% CI: 7.61-29.53) were significantly more likely to receive PARPi monotherapies than patients treated in 2017. Race, region of residence, practice type, FIGO stage at initial diagnosis, Eastern Cooperative Oncology Group (ECOG) score, residual disease status, and other disease characteristics were not selected into the model. Conclusions: Over the last four years, the use of 1L PARPi maintenance among ovarian cancer patients has increased significantly, mostly driven by biomarker status. However, stage and extent of residual disease after surgery were not associated with PARPi maintenance use. Objectives: With the advent of poly (adenosine diphosphate [ADP]- ribose) polymerase inhibitors (PARPi), first-line (1L) maintenance therapy in patients with ovarian cancer (OC) has evolved in recent years. This study described the use of 1L maintenance and assessed predictors of 1L PARPi maintenance therapy use among PARPi- eligible patients with OC in a real-world setting. Methods: This retrospective cohort study included patients with newly diagnosed stage III/IV epithelial OC who received the last dose of 1L platinum-based chemotherapy (PBC) between January 1, 2017, and February 28, 2021, from the nationwide Flatiron Health electronic health record-derived database. During the study period, the de-identified data originated from approximately 280 US cancer clinics. The end of the last cycle of 1L PBC was defined as the index date. Patients who started a second-line treatment within two months of the index date were excluded. Multivariable logistic regression was used to identify predictors of 1L PARPi monotherapy use versus active surveillance (AS). Variables included in the model were selected using the stepwise approach. Results: A total of 1010 patients were included in the study; 37.9% and 62.1% of patients received maintenance therapy and AS, respectively. A total of 162 (16.0%) patients received PARPi monotherapies (niraparib 6.3%, olaparib 8.7%, and rucaparib 1.0%), 122 (12.1%) received bevacizumab monotherapy, 33 (3.3%) received bevacizumab + PARPi combination therapies and 66 (6.5%) received other therapies. The median age was 68.0 years (Q1:58.0; Q3:75.0) for AS and 65.0 years (56.0; 71.8) for PARPi monotherapies. Other patient characteristics are shown in Table 1. Patients with BRCA mutation were significantly more likely to receive PARPi monotherapies (odds ratio [OR]: 7.49; 95% CI: 4.21-13.31) than patients with BRCA wild-type. Patients treated in 2019 (OR: 7.57; 95% CI: 3.86-14.86) and 2020 (OR: 14.99; 95% CI: 7.61-29.53) were significantly more likely to receive PARPi monotherapies than patients treated in 2017. Race, region of residence, practice type, FIGO stage at initial diagnosis, Eastern Cooperative Oncology Group (ECOG) score, residual disease status, and other disease characteristics were not selected into the model. Conclusions: Over the last four years, the use of 1L PARPi maintenance among ovarian cancer patients has increased significantly, mostly driven by biomarker status. However, stage and extent of residual disease after surgery were not associated with PARPi maintenance use.