Olaparib maintenance versus placebo or standard of care in ovarian cancer: a biomarker-driven systematic review and meta-analysis of randomized trials
In brief
Olaparib halves progression risk in ovarian cancer, three-quarters in BRCA-mutated
In eight randomized trials, maintenance olaparib reduced the chance of disease progression by about 50% overall and by roughly 70% in patients with BRCA mutations, with similar benefits seen in HRD-positive tumors. Overall survival showed a modest trend, but severe side effects were more common, underscoring the need to balance efficacy with toxicity.
- Journal
- International journal of clinical oncology (Q1)
- Published
- 4 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Farida Namozova, Isadora Mamede, Carolina Alves Felippe, Ellen Rodrigues, Carlos Stecca
- PMID
- 42550402
- DOI
- 10.1007/s10147-026-03144-6
Why clinicians should know about it
- Picked for Biochemistry (medical) (top studies of the week, 9 August 2026).
- Picked for Hematology (top studies of the week, 9 August 2026).
- Picked for Family Practice (paper of the day, 5 August 2026).
- Picked for Oncology and Radiation Oncology (paper of the day, 5 August 2026): Olaparib improves PFS, especially in BRCA‑mutated ovarian cancer
Abstract
BACKGROUND: Olaparib is widely used as maintenance therapy in advanced ovarian cancer following response to platinum-based chemotherapy, but the magnitude of benefit across molecular subgroups and its safety profile remain uncertain. This updated meta-analysis evaluated the efficacy and safety of olaparib maintenance therapy across biomarker-defined subgroups and treatment settings. METHODS: PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials. Two reviewers independently screened studies evaluating olaparib as maintenance therapy in patients with advanced ovarian cancer who achieved a response to platinum-based chemotherapy in either first-line or recurrent disease settings. RESULTS: Primary endpoints were overall survival (OS) and progression-free survival (PFS). Secondary endpoints included time to first subsequent therapy (TFST), time to second subsequent therapy (TSST), and adverse events (AEs). Hazard ratios (HRs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Eight randomized trials were included. Olaparib significantly improved PFS compared with control (HR 0.48; 95% CI 0.37-0.62; p < 0.01). The benefit was greater in BRCA-mutated patients (HR 0.33; 95% CI 0.22-0.52) than in BRCA wild-type patients (HR 0.62; 95% CI 0.47-0.82; p for interaction = 0.001). The largest benefit was observed in HRD-positive tumors (HR 0.44; 95% CI 0.35-0.54), whereas evidence of benefit in HRD-negative patients remained limited. OS showed a trend toward improvement overall (HR 0.82; 95% CI 0.66-1.02; p = 0.07) and was significantly improved among BRCA-mutated patients (HR 0.66; 95% CI 0.56-0.78). Olaparib also prolonged TFST and TSST but was associated with a higher risk of grade ≥ 3 AEs, without a statistically significant increase in hematologic adverse events. CONCLUSION: Olaparib maintenance therapy significantly delays disease progression in advanced ovarian cancer, with the greatest benefit observed in BRCA-mutated and HRD-positive tumors. These findings support the role of olaparib maintenance therapy in biomarker-selected patients across first-line and recurrent treatment settings, while highlighting ongoing uncertainties in specific biomarker-defined subgroups.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.