Maintenance with a PARP inhibitor improved progression-free survival (PFS) in all subsets of patients with platinum-sensitive, recurrent, high-grade ovarian cancer included in a meta-analysis published in Cancer.
The meta-analysis encompassed 4 randomized clinical trials (ClinicalTrials.gov Identifiers: NCT01874353, NCT01968213, NCT00753545, and NCT001847274) comparing PARP inhibitor maintenance to placebo.
In the pooled data, there were 530 patients who received placebo and 972 who received a PARP inhibitor, including olaparib (31%), niraparib (35%), and rucaparib (34%).
Patients were grouped into 4 subsets according to BRCA status: germline BRCA mutation (gBRCAm), somatic BRCA mutation (sBRCAm), wild-type BRCA (wtBRCA) homologous recombinant-deficient (HRD), and wtBRCA homologous recombinant-proficient (HRP).
All patient subsets had hazard ratios (HRs) for PFS that favored maintenance with a PARP inhibitor.
The greatest PFS benefit from PARP inhibitor maintenance was seen among patients with BRCA mutations (BRCAm). Specifically, patients with gBRCAm1 had a pooled HR of 0.29 (95% CI, 0.23-0.37), patients with gBRCAm2 had a pooled HR of 0.26 (95% CI, 0.17-0.39), and patients with sBRCAm had a pooled HR of 0.22 (95% CI, 0.12-0.41).
Patients with wtBRCA HRD tumors also had improved PFS with PARP inhibitor maintenance (HR=0.41; 95% CI, 0.31-0.56), as did patients with wtBRCA HRP tumors (HR=0.64; 95% CI, 0.49-0.83).
“Although patients with BRCAm derive the greatest benefit, the absence of a BRCAm or HRD could not be used to exclude patients from maintenance PARP [inhibitor] therapy,” the study authors concluded.
Disclosures: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Lee CK, Friedlander ML, Tjokrowidjaja A, et al. Molecular and clinical predictors of improvement in progression-free survival with maintenance PARP inhibitor therapy in women with platinum-sensitive, recurrent ovarian cancer: a meta-analysis. Cancer. Published online March 19, 2021. doi:10.1002/cncr.33517