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Abstract
Objectives Poly(ADP-ribose) polymerase inhibitors (PARPis) have been recommended since 2017 as second-line (2L) maintenance treatment by the NCCN for ovarian cancer (OC) patients with or without BRCA1 or BRCA2 (BRCA) alterations. Here, we assessed PARPi use from real-world data.
Methods From the iKnowMed electronic health record database of the US Oncology Network (>470 sites), adult females were included if they were diagnosed with advanced OC, received a 2L platinum-containing regimen for advanced OC, and had ≥2 visits between 1 January 2016 and 1 July 2020. Patients were followed until 31 October 2020, last patient record, or death, whichever occurred earliest. A 24-month landmark survival analysis was performed.
Results Out of 11,494 patients diagnosed with advanced OC, 1051 met the inclusion criteria; 513/1051 (49%) subsequently received any maintenance therapy (table 1). The proportion of patients receiving 2L PARPi maintenance increased from 17% in 2018 to 34% in 2019 but decreased to 22% in 2020 (figure 1). Among BRCA+patients, 33% (46/140) received 2L PARPi maintenance, while documented BRCA–patients received PARPi maintenance at a significantly lower rate (23%; 155/622; P=0.0192). Survival at 24 months was significantly higher with PARPi maintenance vs active surveillance: 61.2% (95% CI, 52.4%–68.8%) vs 53.0% (95% CI, 47.1%–58.7%; log-rank P=0.0045) (figure 2).
Propotion of patients receiving 2L PARPi maintenance (active surveillance)
Overall survival
Conclusions Our data suggest a significant proportion of eligible patients are not receiving 2L maintenance therapy despite treatment guideline recommendations and apparent survival benefits associated with its use.