Parp Inhibitors As Maintenance Therapy In Newly Diagnosed Advanced Ovarian Cancer: A Meta-Analysis

Background 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. Objectives To investigate the efficacy of PARP inhibitors (PARPis) as maintenance treatment in patients with newly diagnosed advanced ovarian cancer. Search strategy PubMed, MEDLINE, EMBASE, Cochrane Library and Web of Science databases. Selection criteria All randomised clinical trials (RCTs) that compared PARPis with placebo as first-line maintenance therapy in ovarian cancer. Data collection and analysis Two reviewers extracted data. Pooled hazard ratio (HR) and risk ratio (RR) with 95% confidence interval (CI) were calculated. Main results PARPis were associated with significant improvement of progression-free survival (PFS) in advanced epithelial ovarian cancer (AeOC) (HR = 0.53, 95% CI 0.40-0.71;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). Conclusions 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. Tweetable abstract PARPis provide a significant PFS benefit as first-line maintenance therapy in patients with newly diagnosed advanced ovarian cancer.