Efficacy and safety of PARP inhibitors in older patients with advanced ovarian cancer: a systematic review and network meta-analysis

Why clinicians should know about it

• Picked for Geriatrics and Gerontology (top studies of the week, 26 July 2026).
• Picked for Hematology (top studies of the week, 26 July 2026).
• Picked for Oncology and Radiation Oncology (top studies of the week, 26 July 2026): PARP inhibitors improve PFS in older advanced ovarian cancer patients

Abstract

BACKGROUND: Older adults with advanced ovarian cancer (AOC) are underrepresented in randomized clinical trials (RCTs), limiting age-specific evidence on poly(ADP-ribose) polymerase inhibitors (PARPi). This network meta-analysis (NMA) compares PARPi efficacy and safety across age groups. METHODS: We searched PubMed, Embase, and Web of Science until January 20, 2026, for RCTs evaluating PARPi in adults with AOC. Screening and extraction utilized Nested Knowledge. Risk of bias was assessed via RoB 2. A frequentist NMA estimated hazard ratios (HR) and odds ratios (OR) with 95% CIs. Treatment rankings utilized P-scores. RESULTS: A total of 13 RCTs were included. In younger patients, olaparib (HR, 0.32; 95% CI, 0.19-0.54), rucaparib (HR, 0.33; 95% CI, 0.16-0.69), and niraparib (HR, 0.53; 95% CI, 0.38-0.74) significantly improved progression-free survival (PFS) compared with placebo or chemotherapy. Similar benefits were observed in older patients (≥65 years), with significant PFS improvements for olaparib (HR, 0.44; 95% CI, 0.25-0.77), rucaparib (HR, 0.43; 95% CI, 0.19-0.97), and niraparib (HR, 0.56; 95% CI, 0.38-0.83). In the overall adult population, senaparib, veliparib, and olaparib were associated with significant improvements in PFS. Regarding safety, niraparib was associated with increased odds of treatment-emergent adverse events (OR, 3.80; 95% CI, 1.72-8.39), while both niraparib and olaparib were associated with higher risks of grade ≥3 anaemia and other hematologic toxicities. Placebo or chemotherapy ranked most favourably across most safety outcomes. Substantial heterogeneity was observed across several efficacy networks, and most treatment comparisons relied on indirect evidence. CONCLUSIONS: PARP inhibitors improved progression-free survival across age groups, including patients aged ≥65 years. However, treatment was associated with increased hematologic and gastrointestinal toxicities. Further studies should assess geriatric outcomes, long-term safety, and patient-reported outcomes.

Abstract as published, via PubMed.