Poly (ADP-ribose) polymerase inhibitors (PARPi) for treating advanced epithelial ovarian cancer.
Karim H El-Shakankery, Mohamed Shawky, Thomas Grainger et al.
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In 30 seconds
This Cochrane systematic review and meta-analysis assessed randomised trials of PARP inhibitors (PARPi) in women with newly diagnosed or recurrent epithelial ovarian cancer. It included 24 studies with 8961 participants. For newly diagnosed advanced disease, maintenance PARPi after chemotherapy improved progression-free survival versus placebo (HR 0.51, 95% CI 0.41 to 0.64; 7 studies, 3618 participants; high-certainty evidence), while increasing grade 3 or higher adverse events (RR 2.66, 95% CI 1.66 to 4.27; high-certainty evidence). Overall-survival benefit remained uncertain, with low-certainty evidence.
Key findings
- In newly diagnosed advanced disease, maintenance PARPi improved progression-free survival versus placebo (HR 0.51, 95% CI 0.41 to 0.64; 7 studies, 3618 participants).
- Grade 3 or higher adverse events increased with maintenance PARPi in newly diagnosed disease (RR 2.66, 95% CI 1.66 to 4.27; 7 studies, 3648 participants).
- Newly diagnosed disease overall survival may improve, but the estimate was uncertain (HR 0.80, 95% CI 0.58 to 1.10; 5 studies, 2852 participants).
- In recurrent, platinum-sensitive disease, maintenance PARPi improved progression-free survival versus placebo (HR 0.34, 95% CI 0.28 to 0.40; 6 studies, 2194 participants).
Why it matters
The review indicates that PARPi maintenance can substantially delay progression in both newly diagnosed advanced and recurrent platinum-sensitive epithelial ovarian cancer. This benefit needs to be considered alongside increased severe adverse events, while overall-survival effects are less certain. The findings support weighing disease control, toxicity, quality of life, and uncertainty in survival outcomes when evaluating this treatment approach.
What to keep in mind
The review combined trials of different PARPi and comparators, and results showed substantial heterogeneity for several newly diagnosed outcomes. Overall-survival estimates were uncertain and may be confounded by subsequent PARPi use after relapse.