236P - Front-line maintenance therapy for platinum-sensitive ovarian cancer: What’s next PARP inhibitors?

Background

The SOLO1 study revealed upfront maintenance olaparib led to a significantly longer progression-free survival (median PFS>54.3 months) in patients with platinum-sensitive ovarian cancer and germline 1/2 BRCA mutation. Using multiple-treatment meta-analysis and the American Society of Clinical Oncology (ASCO) value framework, we aim to identify additional and potential PARP inhibitors for frontline treatment in such patients.

Methods

Assessment of key maintenance PARPis in platinum-sensitive ovarian cancer was conducted on the following phase III RCTs: olaparib (SOLO1, SOLO2); rucaparib (ARIEL3); and niraparib (NOVA). The primary outcomes for multiple-treatment meta-analysis were efficacy (HRs for PFS) and toxicity (ORs for all grade 1-2 and grade 3-4 AEs). The ASCO value framework was used to assess the cost-effectiveness of the maintenance PARPis based on clinical benefit, toxicity, bonus points and monthly drug acquisition cost (DAC).

Results

The network meta-analysis indicated that all maintenance PARPis provided significantly improved PFS and increased total grade 1-2 and grade 3-4 AEs in patients with platinum-sensitive relapsed ovarian cancer and germline 1/2 BRCA mutation compared to placebo. No statistically significant difference was observed in efficacy and toxicity among the relapsed maintenance PARPis (95%CI included 1). The ASCO value framework indicated relapsed maintenance niraparib was considered as the most cost-effective PARPi regimens for patients with relapsed ovarian cancer ($261.39 per unit of NHB) and germline 1/2 BRCA mutation. Lower monthly DAC is a significant advantage to niraparib. Upfront maintenance olaparib ($260.57 per unit of NHB) is more cost-effective than the relapsed maintenance olaparib ($293.88 per unit of NHB) in the gBRCA mutation cohort.

Conclusions

Early use of PARPis in the therapeutic course of platinum-sensitive ovarian cancer was recommended in the gBRCA mutation cohort. Niraparib is a promising candidate for next front-line maintenance therapy in such patients.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The author.

Funding

The National Natural Science Foundation of China.

Disclosure

The author has declared no conflicts of interest.