Currently, olaparib and bevacizumab are both approved by the US FDA as first-line maintenance therapy of ovarian cancer. In the phase 3 PAOLA study, olaparib plus bevacizumab was used as maintenance treatment in ovarian cancer patients who had response after first-line platinum-taxane chemotherapy plus bevacizumab. In the intent-to-treat population, the median PFS was 22.1 months for the combination group and was 16.6 months for the control group (placebo plus bevacizumab) (HR 0.59, 95% CI 0.49-0.72). In patients with BRCA mutation, the addition of olaparib improved the median PFS from 21.7 to 37.2 months (HR 0.31, 95% CI 0.20-0.47). Moreover, BRCA wild-type patients were classified into homologous recombination repair deficiency (HRD) and HRD-negative groups. The combination of olaparib and bevacizumab significantly improved the median PFS when compared with the control group in the HRD-positive population (28.1 vs. 16.6 months, HR 0.43, 95CI 0.28-0.66). By contrast, the median PFS was similar for both groups in HRD-negative patients (16.9 vs. 16.6 months, HR 0.92, 95% CI 0.72-1.17). Based on these results, the addition of olaparib to bevacizumab maintenance therapy can prolong the PFS in ovarian cancer patients who have a BRCA mutation or HRD.
N Engl J Med. 2019 Dec 19;381(25):2416-2428.
Annals of Oncology (2019) 30 (suppl_5): v851-v934.