Comparison of Different Maintenance Treatment Options for Newly Diagnosed <i>BRCA</i> wt Advanced Ovarian Cancer: A Retrospective Cohort Analysis

IntroductionNiraparib and bevacizumab are two principal maintenance therapies for newly diagnosed advanced ovarian cancer (AOC) patients with <i>BRCA</i> wild-type (<i>BRCA</i>wt) status, regardless of homologous recombination deficiency (HRD). In China, however, a considerable proportion of <i>BRCA</i>wt patients have unknown or untested HRD status, complicating treatment selection.MethodsTo evaluate and compare the efficacy of niraparib and bevacizumab as maintenance therapy for <i>BRCA</i>wt AOC, we conducted a retrospective cohort study using real-world clinical data. Descriptive statistics were used to summarize clinical and demographic characteristics. Progression-free survival (PFS) was estimated using Kaplan-Meier analysis and compared using a stratified Cox proportional hazards model. A multivariable Cox regression was performed to adjust for potential confounding variables. Exploratory subgroup analyses were conducted, and propensity score matching (PSM) was applied as a sensitivity analysis.ResultsA total of 94 patients were included, with 51 receiving niraparib and 43 receiving bevacizumab. The median PFS was not reached in the niraparib group versus 13.77 months (95% CI, 4.12-23.41) in the bevacizumab group (HR = 0.240, 95% CI, 0.128-0.451; <i>P</i> < .001). After covariate adjustment, the median PFS was 19.55 months (95% CI, 9.40-NA) with niraparib and 8.64 months (95% CI, 4.53-NA) with bevacizumab, with an adjusted HR of 0.282 (95% CI, 0.136-0.587; <i>P</i> = .001). In the PSM sensitivity analysis, the median PFS was not reached (95% CI, 19.55-NR) in the niraparib group and was 18.33 months (95% CI, 8.90-25.26) in the bevacizumab group (HR = 0.360, 95% CI, 0.176-0.736; <i>P</i> = .005).ConclusionThis analysis suggests that niraparib may provide a progression-free survival advantage compared with bevacizumab in <i>BRCA</i>wt AOC patients, with both regimens appearing to be generally well tolerated in the real-world setting. These findings offer preliminary reference value for maintenance treatment selection in patients with newly diagnosed <i>BRCA</i>wt AOC.