Introduction To compare survival outcomes between bevacizumab (BEV) and poly(ADP-ribose) polymerase (PARP) inhibitors in BRCA-mutated, platinum-sensitive relapsed (PSR) high-grade serous ovarian carcinoma (HGSOC).

Methods From the institution’s ovarian cancer cohort, we identified HGSOC patients with germline and/or somatic BRCA1/2 mutations who experienced platinum-sensitive recurrence between 2013 and 2022 and received second-line platinum-based combination chemotherapy. Among them, patients who received BEV or PARP inhibitors were included, while those who had received BEV or PARP inhibitors during primary treatment and those who showed stable disease or progressed despite the second-line combination chemotherapy were excluded. Between the BEV and PARP inhibitor groups, baseline clinicopathologic characteristics and survival outcomes were compared.

Results In total, 33 and 69 patients were included in the BEV and PARP inhibitor groups. Olaparib was the predominant PARP inhibitor (n=40), followed by niraparib (n=29). Overall, the PARP inhibitor group showed significantly better progression-free survival (PFS) than BEV users (median, 28.0 vs. 17.4 months; P=0.004), but similar overall survival (P=0.163). Between the olaparib and niraparib users, no difference in PFS was observed. In multivariate analyses adjusting confounders, the use of PARP inhibitors was identified as an independent favorable prognostic factor for PFS (adjusted HR, 0.505; 95% CI, 0.280-0.911; P=0.023). Different toxicity profiles were observed between the BEV and PARP inhibitor groups.

Conclusion/Implications Compared to BEV, PARP inhibitor maintenance therapy was significantly associated with decreased disease recurrence risk in patients with BRCA-mutated, PSR HGSOC.