{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T17:39:51Z","timestamp":1790098791489,"version":"4.0.1"},"reference-count":38,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Poly (ADP-ribose) polymerase inhibitors (PARPi) are the standard of care for first-line maintenance in advanced ovarian cancer, but their benefit varies by BRCA and homologous recombination deficiency (HRD) status, and no head-to-head comparisons are available. Methods: We conducted an indirect comparison of PARPi regimens using reconstructed individual patient data (IPD) from Kaplan\u2013Meier curves of phase III randomized trials (SOLO1, PRIMA, PAOLA1, ATHENA, FLAMES). Progression-free survival (PFS) was the primary endpoint; overall survival (OS) was exploratory. Subgroups were defined as BRCA\u2212mutated (BRCA+), BRCA\u2212\/HRD+, and BRCA\u2212\/HRD\u2212. Safety outcomes were assessed through a network meta-analysis of adverse drug reactions (ADRs). Results: In BRCA+ patients, olaparib + bevacizumab achieved the largest PFS improvement (HR = 0.27; 95%CI: 0.19\u20130.39), followed by olaparib monotherapy, while niraparib performed significantly worse. In BRCA\u2212\/HRD+, olaparib + bevacizumab was superior to niraparib and rucaparib, with restricted mean survival time (RMST) gains of 3\u20134 months. In BRCA\u2212\/HRD\u2212, PARPi produced only a modest benefit, with no advantage over bevacizumab monotherapy. Exploratory OS analysis confirmed long-term survival with olaparib in BRCA+ but not in the other subgroups. Safety analysis indicated olaparib had the most favorable hematological profile, while niraparib was associated with the highest rates of severe anemia, thrombocytopenia, and neutropenia, despite showing lower gastrointestinal toxicity and fatigue incidence. Conclusions: PARPi efficacy depends strongly on BRCA and HRD status. Olaparib-based regimens provide the greatest clinical benefit with acceptable safety in BRCA+ and HRD+ disease, whereas PARPi appear to be of limited value in HRD-negative ovarian cancer.<\/jats:p>","DOI":"10.3390\/cancers17223714","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T10:30:59Z","timestamp":1763634659000},"page":"3714","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Comparative Analysis of Maintenance Treatments in Patients with Newly Diagnosed Advanced Ovarian Cancer After First-Line Platinum-Based Regimens"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6427-0809","authenticated-orcid":false,"given":"Lorenzo","family":"Gasperoni","sequence":"first","affiliation":[{"name":"Oncological Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) \u201cDino Amadori\u201d, 47014 Meldola, Emilia Romagna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6409-4195","authenticated-orcid":false,"given":"Luca","family":"Cancanelli","sequence":"additional","affiliation":[{"name":"Hospital Pharmacy Department, Azienda Ulss 2 Marca Trevigiana, 31100 Treviso, Italy"},{"name":"Italian Society of Clinical Pharmacy and Therapeutics (SIFaCT), 10123 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8984-4733","authenticated-orcid":false,"given":"Andrea","family":"Ossato","sequence":"additional","affiliation":[{"name":"Italian Society of Clinical Pharmacy and Therapeutics (SIFaCT), 10123 Turin, Italy"},{"name":"UOC Territorial Pharmaceutical Service, Azienda ULSS 8 Berica, 36100 Vicenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luna","family":"Del Bono","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, School of Specialization in Hospital Pharmacy, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0578-0870","authenticated-orcid":false,"given":"Stefano","family":"Vecchia","sequence":"additional","affiliation":[{"name":"Hospital Pharmacy Unit, Ospedale Guglielmo da Saliceto, 29121 Piacenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Fontanella","sequence":"additional","affiliation":[{"name":"Oncology and Oncohematology Unit, Vittorio Veneto Hospital, AULSS2 Marca Trevigiana, 31029 Vittorio Veneto, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera","family":"Damuzzo","sequence":"additional","affiliation":[{"name":"Hospital Pharmacy Department, Azienda Ulss 2 Marca Trevigiana, 31100 Treviso, Italy"},{"name":"Italian Society of Clinical Pharmacy and Therapeutics (SIFaCT), 10123 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5829-107X","authenticated-orcid":false,"given":"Andrea","family":"Messori","sequence":"additional","affiliation":[{"name":"HTA Unit, Regional Health Service, 50139 Florence, Italy"},{"name":"Italian Society of Clinical and Therapeutic Pharmacy, 10123 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"ref_1","unstructured":"Ferlay, J., Ervik, M., Lam, F., Laversanne, M., Colombet, M., M\u00e9ry, L., Pi\u00f1eros, M., Znaor, A., Soerjomataram, I., and Bray, F. 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