Maintenance Therapy with Poly (Adp-Ribose) Polymerase Inhibitors (Parpi) in Patients with Newly Diagnosed Ovarian Cancer: A Systematic Review and Meta-Analysis

Al-Alam O, Stecca C, Michelon I, Vilbert M, Castro C, Dacoregio MI, Da Costa AABA, Gaillard S and Nogueira-Rodrigues A

Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore Department of Medicine, Division of Medical Oncology, Evangelical Mackenzie University Hospital, Brazil Department of Medicine, Catholic University of Pelotas, Brazil Department of Medicine, Division of Hematology/Oncology, Mass General Cancer Center, Massachusetts General Hospital, USA Harvard Medical School, Boston, USA Department of Medicine, University of Brasilia, Brazil Department of Medicine, University of Centro-oeste, Brazil Department of Medicine, Division of Medical Oncology, AC Camargo Cancer Center, Brazil Federal University of Minas Gerais (UFMG), Brazil Oncoclínicas&Co, Brazil Brazilian Group of Gynecologic Oncology (EVA) DOM Oncologia, Brazil

^*Correspondance to: Al-Alam O 

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Abstract:

Background: PARP inhibitors (PARPi) have demonstrated efficacy in maintenance therapy for newly diagnosed ovarian cancer, particularly in patients with BRCA pathogenic variants and Homologous Recombination Deficiency (HRD). However, in recent updates from the PRIMA trial, no overall survival benefit was observed across all subgroups. This systematic review and meta analysis evaluate the efficacy and safety of PARPi based on this clinical context. Methods: A systematic search of PubMed, Cochrane, and Embase was conducted for randomized controlled trials comparing PARPi with placebo in newly diagnosed ovarian cancer. Outcomes included Overall Survival (OS) and Progression-Free Survival (PFS), by BRCA and HRD status, Adverse Events (AEs), and rates of Myelodysplastic Syndrome (MDS) or Acute Myeloid Leukemia (AML). This meta-analysis followed PRISMA guidelines (PROSPERO: CRD42024603696) and used random-effects models across all analyses. Results: Seven Randomized Clinical Trials (RCTs) with 4,013 patients were included. In patients with BRCA pathogenic variants, PARPi significantly improved OS [HR 0.67, 95% CI 0.48–0.93, p=0.02] and PFS [HR 0.38, 95% CI 0.32-0.44, p<0.01]. No OS benefit was observed in HRD test positive [HR 0.77, 95% CI 0.51-1.17, p=0.22] or HRD test-negative [HR 1.05, 95% CI 0.85-1.30, p=0.66] groups. PFS was significantly improved in HRD test-positive patients [HR 0.45, 95% CI 0.38-0.55, p<0.01] and HRD test-negative patients [HR 0.73, 95% CI 0.61-0.88, p<0.01]. Grade ≥ 3 AEs were more common in the PARPi group (p<0.01), with non-significant increases in MDS or AML rates. Conclusion: PARPi maintenance therapy improves OS in ovarian cancer patients with BRCA pathogenic variants, and PFS across all subgroups regardless of HRD test.

Keywords:

Ovarian Cancer; PARP inhibitor; Maintenance

Cite the Article:

Al-Alam O, Stecca C, Michelon I, Vilbert M, Castro C, Dacoregio MI, et al. Maintenance Therapy with Poly (Adp Ribose) Polymerase Inhibitors (Parpi) in Patients with Newly Diagnosed Ovarian Cancer: A Systematic Review and Meta-Analysis. Clin Oncol. 2025; 10: 2123..