Findings from a real-world study found that most patients with ovarian cancer do not receive first-line maintenance therapy, but those who did receive maintenance therapy experienced improved progression-free survival (PFS) vs those who did not.

In recent years, treatment options for first-line maintenance therapy in ovarian cancer have expanded with the FDA approvals of PARP inhibitors.

This study aimed to describe real-world use and outcomes of first-line maintenance compared with active among patients with ovarian cancer who were eligible to be treated with PARP inhibitors (prior to the 2020 FDA approval for olaparib).

The Flatiron Health database was used to identify 463 patients with newly diagnosed stage III/IV ovarian cancer who received 6-9 cycles of first-line platinum-based chemotherapy and either primary debulking surgery or interval debulking surgery following neoadjuvant chemotherapy between January 1, 2016 and February 29, 2020.

The index date for this study was the end of the last cycle of first-line platinum-based chemotherapy. The primary end point was defined as time to initiation of second-line systemic therapy or death.

 Adjustments for baseline differences among patients on maintenance therapy and patients on active surveillance, including age, race, stage of cancer, and BRCA status, were performed using inverse probability of treatment weighting and Cox proportional hazard model.

Among participants in this study, 87.7% were from community practices, and 12.3% were from academic institutions. Maintenance therapy was received by only 21% of participants, with 48.5% of these participants receiving bevacizumab, 40.2% receiving olaparib plus rucaparib, and 11.3% receiving paclitaxel.

For patients who received first-line maintenance therapy, the median PFS was 16.1 months, while only 12.2 months for those who did not receive first-line maintenance therapy.

Once baseline differences among patients were identified, investigators determined that patients on maintenance therapy had a significantly lower risk (29%) of progression or death compared to patients receiving active surveillance (hazard ratio: .71; 95% CI, 0.52–0.99; P = .04).

“In this real-world analysis, the majority of patients did not receive maintenance therapy; however, a progression-free survival benefit was found in those receiving maintenance therapy” wrote Dr Jinan Liu, MD, PhD, GlaxoSmithKline, Navy Yard, PA, and colleagues, concluding, “Further studies are needed to understand how biomarker status drives practice patterns.”—Marta Rybczynski