Efficacy and Safety of Olaparib Combined With Cediranib in the Treatment of Ovarian Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Introduction Ovarian cancer (OC) remains one of the most lethal gynecologic malignancies. Olaparib plus cediranib has shown therapeutic promise, but its efficacy and safety remain inconclusive. Objectives To evaluate the efficacy and safety of olaparib plus cediranib compared with other treatments in the maintenance treatment of OC. Design Systematic review and meta-analysis. Data sources and Methods Following PRISMA 2020, we searched PubMed, Web of Science, Scopus, CNKI, and Wanfang databases up to June 2026 for RCTs comparing the combination with control treatments. Risk of bias was assessed using RoB 2, and certainty of evidence was evaluated using GRADE. Results Nine RCTs with 1,683 patients were included. Across all comparators, the combination significantly prolonged progression-free survival (PFS) (overall HR = 0.78; 95% CI: 0.68–0.89; P < 0.001). No significant benefit was observed in overall survival (OS) or overall objective response rate (ORR), demonstrated improved ORR compared with olaparib or cediranib monotherapy, but not compared with chemotherapy or olaparib plus durvalumab. The combination significantly improved PFS in the BRCA wild-type/unknown subgroup (HR = 0.79, 95% CI: 0.65–0.97; P = 0.020), whereas no statistically significant benefit was observed in the BRCA-mutated subgroup (HR = 0.77, 95% CI: 0.54–1.11; P = 0.160). There was no statistical evidence that BRCA mutation status modified the treatment effect. It increased risks of gastrointestinal, vascular, and fatigue-related adverse events, while reducing some hematologic toxicities. Evidence certainty ranged from very-low to moderate. Conclusion Olaparib plus cediranib may prolong PFS in OC, and the benefit may limit in BRCA-mutated populations, but no clear OS benefit was observed and toxicity was increased. Because trials were judged to be at high risk of bias and the certainty of evidence ranged from very-low to moderate, these findings should be interpreted cautiously and considered hypothesis-generating.