Comparing efficacy and safety of Maintenance Therapy for Platinum-Sensitive Recurrent Ovarian Cancer: A Bayesian network meta-regression analyses

Abstract Background Despite surgical and medical efforts in the upfront treatment, about 70% of OC patients have a disease relapse within 2–3 years after diagnosis. ROC is still an incurable condition; targeted agents as maintenance therapies have been shown to improve survival, but the most appropriate maintenance regimens are still controversial and opaque. Objective This Bayesian network meta-regression analysis provides a head-to-head comparison of maintenance therapy PARP-Inhibitors and Angiogenesis Inhibitors for Platinum-Sensitive Recurrent Ovarian Cancer(PSROC) using the BRCA genes status as a covariate. Methods To identify relevant studies, the databases of Pubmed, Scopus, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched until January 31, 2023. Comparing progression-free survival (PFS) and overall survival (OS) of different interventions at the same time node by NMA. NMR was performed on the hazard ratios (HR) associated with PFS and OS as the primary endpoints, with the BRCA genes status as the covariate. The ability of each treatment was ranked using the surface under the cumulative ranking (SUCRA) curve. Results Eventually,16 studies with 5696 patients and 8 maintenance therapy were enrolled.From a horizontal perspective,bevacizumab(HR = 1.83, 95%CI: 1.47 to 2.33), niraparib(HR = 2.9, 95%CI: 2.15 to 3.95), olaparib (HR = 2.74, 95%CI: 2.05 to 3.6) ,rucaparib (HR = 2.61, 95%CI: 1.81 to 3.57) and fuzuloparib (HR = 3.99, 95%CI: 2.41 to 6.6) were significantly superior to the placebo on PFS of AC.Niraparib(HR = 4.08, 95%CI: 1.49 to 11.33), olaparib (HR = 4.29, 95%CI: 1.9 to 9.75) ,rucaparib (HR = 4.16, 95%CI: 1.04 to 16.49) and fuzuloparib(HR = 7.16, 95%CI: 1.63 to 30.82) were significantly superior to the placebo on PFS of BRCAm.Niraparib(HR = 2.33, 95%CI: 1.17 to 4.7) was significantly superior to the placebo on PFS of BRCAwt.From a longitudinal perspective, the results for PFS are similar to the above; Olaparib significantly increased OS rates from the 3rd to the 36th month(HR from4.43 to26.55). Meta-regression analyses support the above conclusions. Conclusions Considering the efficacy, durability, safety, and compliance, one of the standard maintenance therapy, Olaparib, should be recommended as the best choice for PSROC. For BRCAm and BRCAwt patients,Olaparib and niraparib may be the first choice for improving PFS.Furthermore, more head-to-head trials are needed to confirm those findings.