Data Support Niraparib Combo as First-Line Maintenance in Ovarian Cancer

In a conversation with CancerNetwork®, Melissa Hardesty, MD, MPH, spoke about subgroup data from the phase 2 OVARIO trial (NCT03326193) as well as considerations for sequencing niraparib (Zejula) plus bevacizumab (Avastin) maintenance therapy for patients with advanced ovarian cancer. According to findings that she presented at the 2025 Society of Gynecologic Oncology Annual Meeting on Women’s Cancer (SGO), the overall results achieved with niraparib/bevacizumab maintenance after frontline chemotherapy plus bevacizumab were consistent with known findings for PARP inhibition in combination with bevacizumab as maintenance therapy for this patient population.

Hardesty, a board-certified gynecologic oncologist and managing partner at Alaska Women’s Cancer Care, highlighted that the most prominent overall survival (OS) benefit with the niraparib combination occurred in patients with homologous recombination repair (HRR)–deficient tumors and those with BRCA-mutated disease. In the poster presentation, the study authors noted that these subgroup data should be interpreted with caution due to the small number of patients.

Based on the study’s overall findings, Hardesty stated that niraparib plus bevacizumab would provide the biggest benefit in the first-line maintenance setting for patients with advanced ovarian cancer. Although bevacizumab alone has demonstrated utility at multiple sequencing points, she described that the combination therapy, specifically, may not have a large role in later lines of treatment.

Transcript:

[It] is definitely the [HRR]–deficient and the BRCA mutation carrier [subgroups that benefitted the most], which is not surprising based on other things that have been published up to this point. A [median] OS in the HRR-proficient group of 38.7 months compares very favorably to some other reports, and I think that this combination has activity in that group as well.

Especially as it relates to PARP inhibition, it’s my personal belief that [the niraparib combination’s] biggest benefit to women with advanced ovarian cancer is in a first-line maintenance setting or first-line [setting], but that the risk/benefit of using it and the amount of benefit seen in women is definitely diminished. In terms of sequencing, this is going to be strongest in the front line, largely due to [the fact that] the amount of benefit obtained for women with ovarian cancer from PARP inhibitors is in that range. For bevacizumab, there’s a lot of data that would suggest that it has multiple applications and multiple sequencing points for the treatment of ovarian cancer. For this combination, specifically, this is its place, and I don’t see it having a big role for recurrence or later-line [treatment] as a combination.

Reference

Hardesty MM, Krivak TC, Wright GS, et al. A phase 2 study of niraparib plus bevacizumab maintenance following front-line platinum-based chemotherapy with bevacizumab in advanced ovarian cancer: final analysis from the OVARIO study. Presented at the 2025 Society of Gynecologic Oncology Annual Meeting on Women’s Cancer (SGO); March 14-17, 2025; Seattle, WA.