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In this study, we report the preplanned exploratory biomarker analysis of the L-MOCA trial, which investigated the effects of homologous recombination deficiency (HRD) and programmed cell death ligand 1 (PD-L1) expression on olaparib efficacy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>HRD status was determined using the ACTHRD assay, an enrichment-based targeted next-generation sequencing assay. PD-L1 expression was assessed by SP263 immunohistochemistry assay. PD-L1 expression positivity was defined by the PD-L1 expression on\u2009\u2265\u20091% of immune cells. Kaplan\u2013Meier method was utilised to analyse progression-free survival (PFS).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>This exploratory biomarker analysis included 225 patients and tested HRD status [<jats:italic>N<\/jats:italic>\u2009=\u2009190; positive, <jats:italic>N<\/jats:italic>\u2009=\u2009125 (65.8%)], PD-L1 expression [<jats:italic>N<\/jats:italic>\u2009=\u2009196; positive, <jats:italic>N<\/jats:italic>\u2009=\u200956 (28.6%)], and <jats:italic>BRCA1\/2<\/jats:italic> mutation status (<jats:italic>N<\/jats:italic>\u2009=\u2009219). The HRD-positive patients displayed greater median PFS than the HRD-negative patients [17.9 months (95% CI: 14.5\u201322.1) versus 9.2 months (95% CI: 7.5\u201313.8)]. PD-L1 was predominantly expressed on immune cells. Positive PD-L1 expression on immune cells was associated with shortened median PFS in the patients with germline <jats:italic>BRCA1\/2<\/jats:italic> mutations [14.5 months (95% CI: 7.4\u201318.2) versus 22.2 months (95% CI: 18.3\u2013NA)].  Conversely, positive PD-L1 expression on immune cells was\u00a0associated with prolonged median PFS in the patients with wild-type <jats:italic>BRCA1\/2<\/jats:italic> [20.9 months (95% CI: 13.9\u2013NA) versus 8.3 months (95% CI: 6.7\u201313.8)].<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>HRD remained an effective biomarker for enhanced olaparib efficacy in the Asian patients with PSROC. Positive PD-L1 expression was associated with decreased olaparib efficacy in the patients with germline <jats:italic>BRCA1\/2<\/jats:italic> mutations but associated with improved olaparib efficacy in the patients with wild-type <jats:italic>BRCA1\/2<\/jats:italic>.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>NCT03534453. Registered at May 23, 2018.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12916-024-03409-9","type":"journal-article","created":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T23:02:55Z","timestamp":1715900575000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Exploratory biomarker analysis in the phase III L-MOCA study of olaparib maintenance therapy in patients with platinum-sensitive relapsed ovarian 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