Comparison of Different Maintenance Treatment Options for Newly Diagnosed BRCA wt Advanced Ovarian Cancer: A Retrospective Cohort Analysis
Introduction
Niraparib and bevacizumab are two principal maintenance therapies for newly diagnosed advanced ovarian cancer (AOC) patients with BRCA wild-type ( BRCA wt) status, regardless of homologous recombination deficiency (HRD). In China, however, a considerable proportion of BRCA wt patients have unknown or untested HRD status, complicating treatment selection.
Methods
To evaluate and compare the efficacy of niraparib and bevacizumab as maintenance therapy for BRCA wt AOC, we conducted a retrospective cohort study using real-world clinical data. Descriptive statistics were used to summarize clinical and demographic characteristics. Progression-free survival (PFS) was estimated using Kaplan–Meier analysis and compared using a stratified Cox proportional hazards model. A multivariable Cox regression was performed to adjust for potential confounding variables. Exploratory subgroup analyses were conducted, and propensity score matching (PSM) was applied as a sensitivity analysis.
Results
A total of 94 patients were included, with 51 receiving niraparib and 43 receiving bevacizumab. The median PFS was not reached in the niraparib group versus 13.77 months (95% CI, 4.12–23.41) in the bevacizumab group (HR = 0.240, 95% CI, 0.128–0.451; P < .001). After covariate adjustment, the median PFS was 19.55 months (95% CI, 9.40–NA) with niraparib and 8.64 months (95% CI, 4.53–NA) with bevacizumab, with an adjusted HR of 0.282 (95% CI, 0.136–0.587; P = .001). In the PSM sensitivity analysis, the median PFS was not reached (95% CI, 19.55–NR) in the niraparib group and was 18.33 months (95% CI, 8.90-25.26) in the bevacizumab group (HR = 0.360, 95% CI, 0.176–0.736; P = .005).
Conclusion
This analysis suggests that niraparib may provide a progression-free survival advantage compared with bevacizumab in BRCA wt AOC patients, with both regimens appearing to be generally well tolerated in the real-world setting. These findings offer preliminary reference value for maintenance treatment selection in patients with newly diagnosed BRCA wt AOC.