PARP inhibitor maintenance takes advantages in advanced epithelial ovarian cancer but May show a negative impact while recurrence occurs: a multi-center retrospective study in Taiwan.

OBJECTIVE

This study aimed to assess prognosis related to poly (ADP-ribose) polymerase inhibitor (PARPi) maintenance therapy (MT) in newly diagnosed patients with advanced-stage epithelial ovarian cancer (adsOC, primary setting). Additionally, it evaluated the effect on recurrent patients after the front- or second-line PARPi MT (recurrence setting).

METHODS

This multicenter retrospective study analyzed adsOC patients undergoing standard of care therapy (cytoreductive surgery and chemotherapy), regardless whether PARPi MT was followed or not from December 2011 to May 2023. The prognostic factors affecting survival outcomes (progression-free survival [PFS] and overall survival [OS]) in primary and recurrence settings were analyzed.

RESULTS

A total of 218 patients were analyzed, including 25% with BRCAm, 13% with homologous recombination deficiency (HRD), and 62% with homologous recombination proficiency (HRP). The median follow-up was 35.5 months. In primary setting, International Federation of Gynecology and Obstetrics IIIC/IV, Eastern Cooperative Oncology Group (ECOG) >1, neoadjuvant chemotherapy, non-high-grade serous carcinoma (HGSOC) or non-endometrioid, HRP and absence of PARPi MT were associated with worse outcome. In recurrence setting, ECOG >1, platinum-resistance, non-HGSOC or non-endometrioid, non-BRCAm and previous PARPi MT were associated with poor prognosis. Rechallenge of PARPi in recurrent patients did not show statistically different outcome compared to those without PARPi.

CONCLUSION

Besides, the best survival occurring in adsOC patients with BRCAm, HRD patients treated with PARPi MT also experienced significantly prolonged PFS and OS. However, prior frontline PARPi MT was associated with poorer OS if the recurrence occurred. Treatment for recurrence status with PARPi MT did not show survival benefits.