Better outcomes were seen with PARP inhibitors over antiangiogenic agents for first-line maintenance therapy in advanced ovarian cancer, according to a study presented at the 2020 Virtual European Society for Medical Oncology (ESMO) Congress.
This analysis compared the efficacy of PARP inhibitors as they relate to one another, and as they compare to first-line antiangiogenic agents for the of first-line maintenance treatment of ovarian cancer.
Online databases were used to identify patients with a diagnosis of advanced ovarian cancer and first-line maintenance treatment with olaparib, niraparib, veliparib, bevacizumab, pazopanib, nintedanib or control. The review included phase 3 randomized studies with reports of progression, death and adverse events.
A total of 7 studies containing 7,770 participants were included in the analysis.
Patients treated with control and bevacizumab had the highest relative risk of death compared to the other first-line maintenance therapies. Pazopanib was the agent with the highest relative risk of experiencing three or more adverse events.
Additionally, use of PARP inhibitors showed significant improvement in progression-free survival rates in specific groups such as those with homologous-recombinant deficiency (HRD)-positive and -negative, BRCA mutation-positive and -negative, BRCA2-positive and those with stage 3 or 4 disease.
Specific to BRCA-positive patients, PARP inhibitors revealed equivalent decreases in the risk of death and disease progression. In HRD-positive patients, risk rates were lowest for olaparib, and increased for niraparib, veliparib and control, in order. Alternately, HRD-negative patients exhibited the lowest relative risk with veliparib, and increasing risk with niraparib, olaparib and control, in order, but with olaparib and control with seemingly similar results.
This study was able to compare and even rank these first-line maintenance therapies for advanced ovarian cancer, along with highlighting that each individual agent may show variation in efficacy across mutation subtypes and in related adverse events.—Jennifer Spector
Hammoud D, Gallagher KM, Haddad PA. Comparative efficacy of first-line maintenance PARP inhibitors (PARPI) in advanced ovarian cancer (OC): a network meta-analysis. Presented at: 2020 Virtual ESMO Congress. September 14, 2020. Abstract 826P.
