Systematic literature review of efficacy and safety of first-line maintenance therapy trials in advanced ovarian cancer

Aim: To review safety and efficacy outcomes in studies of first-line maintenance therapies for advanced ovarian cancer. Methods: A systematic literature review was performed (27 February 2020) to identify clinical outcomes including progression-free survival (PFS), overall survival (OS) and Grade >= 3 adverse events. Results: Overall 50 references met prespecified criteria; 18 studies evaluated 10 different agents, including PARP inhibitors. PFS was an end point in 16 trials and OS in 12 trials. PARP inhibitors reported better PFS hazard ratios (HRs: 0.59-0.68) compared with other classes; no mature OS data were identified. Safety reporting was inconsistent. Conclusion: Reported PFS HRs were better for PARP inhibitors than for other ovarian cancer maintenance therapies; overall survival data remain immature. Tweetable abstract Systematic literature review of 18 ovarian cancer trials of first-line maintenance therapy demonstrates PARP inhibitors confer greater clinical benefit than other drug classes; niraparib demonstrated significant improvement in progression-free survival beyond BRCA status. Plain language summary This article reports the results from a systematic literature review (SLR), enabling a critical and unbiased comparison of clinical studies, of responses and side effects of first-line maintenance therapies used for advanced ovarian cancer. Overall, this SLR supports the use of PARP inhibitors as maintenance therapy for patients with advanced ovarian cancer as they demonstrated a greater effect on delaying further disease progression than other drug types assessed. However, due to large differences between the clinical studies included (e.g. design of the trial), direct comparisons between first-line maintenance therapies must be made with caution. Healthcare professionals must factor individual patient circumstances when choosing the most appropriate therapy.