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Abstract
Objectives In recent years, PARP inhibitors have shown to be effective as maintenance treatment in patients with advanced ovarian cancer, both in the newly diagnosed and in the recurrent setting. However, as most ovarian carcinomas develop before 65, older patients are underrepresented in clinical trials. We performed a meta-analysis to assess the efficacy of PARP inhibitors as maintenance therapy in older patients with ovarian cancer.
Methods We systematically searched the PubMed, EMBASE, and Cochrane databases for randomized clinical trials (RCTs) concerning maintenance with PARP inhibitors in patients with newly diagnosed or recurrent, advanced, ovarian cancer. We extracted trials including hazard ratios (HRs) for progression-free survival (PFS) stratified by patients’ age (cut-off: 65 years).
Results 7 phase III RCTs were selected. Olaparib, Niraparib, Rucaparib and Veliparib were administered. Among the 4099 treated patients, 1398 (34.1%) were ≥65 (894 receiving PARP inhibitors maintenance and 504 receiving placebo in the control arm). Compared to placebo, maintenance with PARP inhibitors improved PFS in older patients (HR=0.54; 95% CI: 0.44–0.65; P<0.00001). No differences for PFS emerged compared to the young population (HR=0.47; P=0.22).
Conclusions Our meta-analysis demonstrates that maintenance with PARP inhibitors prolongs PFS compared to placebo after chemotherapy in older patients with ovarian cancer. No OS data are disposable yet. Longer follow-up and data from further studies will increase the power of our analysis.