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First-line PARP inhibitor maintenance therapy significantly improves progression-free survival in BRCA-mutated and HR-deficient ovarian cancer in real-world settings, with consistent benefits across different agents, but provides limited benefit in HR-proficient patients. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

May 30, 2026

Progression-free survival outcomes of first-line maintenance therapy in ovarian cancer stratified by BRCA and homologous recombination status: A multi-center real-world analysis.

Key Points

This analysis aims to evaluate progression-free survival outcomes of first-line maintenance therapy in ovarian cancer based on BRCA mutation and homologous recombination status.
Retrospective analysis of medical records from 397 patients with ovarian cancer across four hospitals in South Korea
Patients categorized into BRCA-mutated, HR-deficient, and HR-proficient groups
Kaplan–Meier analysis performed to assess progression-free survival based on maintenance therapy.
In the BRCA-mutated group, median progression-free survival was 58.8 months for maintenance vs. 23.5 months for no maintenance (p < 0.0001).
In the HR-deficient group, median progression-free survival was significantly longer with maintenance (26.9 months) than without it (14.1 months, p < 0.0001).
No significant PFS advantage in the HR-proficient group comparing maintenance therapy to no maintenance (16.5 vs. 12.1 months, p = 0.263).

Abstract

e17596 Background: Poly (ADP-ribose) polymerase (PARP) inhibitors are widely used in ovarian cancer; however, real-world data on survival outcomes by BRCA and homologous recombination (HR) status are limited. We assessed progression-free survival (PFS) across different maintenance agents stratified by BRCA mutation and HR status. Methods: A retrospective analysis was conducted using medical records of patients diagnosed with epithelial ovarian cancer between January 2019 and February 2025 at four tertiary hospitals in South Korea. Patients were categorized into three groups: BRCA -mutated, BRCA wild-type with HR-deficiency (HRd), and BRCA wild-type with HR-proficiency (HRp). In the BRCA -mutated group, PFS was evaluated among patients who received first-line maintenance therapy with niraparib, olaparib, or olaparib plus bevacizumab. In the HRd group, patients treated with bevacizumab, niraparib, or olaparib plus bevacizumab were analyzed, while in the HRp group, patients who received bevacizumab alone or niraparib as first-line maintenance therapy were included. Kaplan–Meier analyses were performed separately within each group to assess the impact of maintenance strategies on PFS. Results: A total of 397 patients were included ( BRCA -mutated, n = 200; HRd, n =126; HRp, n =71). Overall, initial PFS comparisons between maintenance and no-maintenance group were conducted within each subgroup. Maintenance therapy significantly improved PFS in both the BRCA -mutated group (median PFS, 58.8 vs. 23.5 months; p < 0.0001) and the HRd group (26.9 vs. 14.1 months; p < 0.0001), while a nonsignificant trend was observed in the HRp group (16.5 vs. 12.1 months; p = 0.109). Subgroup analyses were subsequently performed to evaluate PFS according to the agent of maintenance therapy. In the BRCA -mutated group, no statistically significant difference in PFS was observed among patients treated with niraparib, olaparib, or olaparib plus bevacizumab (51.9 months vs. not reached vs. not reached; p =0.756). In the HRd group, niraparib and olaparib plus bevacizumab were associated with significantly longer PFS compared with Bevacizumab monotherapy (33.7 and 33.1 vs. 15.9 months; p <0.001), while no significant difference in PFS was observed between niraparib and olaparib plus bevacizumab ( p =0.433). In the HRp group, no significant differences in PFS were observed among patients treated with bevacizumab, niraparib, or no maintenance therapy (18.7 vs. 15.6 vs. 12.1 months; p =0.263). Conclusions: In this real-world analysis, PARP inhibitor maintenance significantly improved PFS in patients with BRCA-mutated and HR-deficient ovarian cancer, with consistent benefit observed across different agents and regimens. In contrast, maintenance therapy provided limited benefit in patients with HR-proficient ovarian cancer.

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