A recent network meta-analysis evaluating poly (ADP-ribose) polymerase (PARP) inhibitor regimens in BRCA-mutated ovarian cancer patients indicates similar efficacy and toxicity profiles across various treatment strategies, but highlights important cost-effectiveness considerations. The study, published in PubMed, assessed patients responsive to front-line platinum (bevacizumab and olaparib, veliparib and chemotherapy, olaparib) or platinum-sensitive relapsed (olaparib, rucaparib, niraparib) treatments in phase III randomized controlled trials.
The meta-analysis compared the efficacy, toxicity, and cost-effectiveness of different PARP inhibitor regimens. The primary outcomes were progression-free survival (PFS) in BRCA-mutated cohorts and the incidence of grade 3-4 adverse events. The American Society of Clinical Oncology (ASCO) value framework was used to assess cost-effectiveness.
Efficacy and Toxicity
The network meta-analysis found no statistically significant differences in efficacy or toxicity among the assessed upfront or relapsed PARP inhibitor regimens (95% CI included 1). This suggests that the choice of PARP inhibitor regimen should not solely rely on efficacy and toxicity considerations.
Cost-Effectiveness Analysis
The ASCO value framework indicated that current PARP inhibitor regimens have similar clinical benefits, toxicity, and net health benefits in both upfront (bevacizumab and olaparib, veliparib and chemotherapy, olaparib) and relapsed settings (olaparib, rucaparib, niraparib). However, the addition of bevacizumab to olaparib increased the cost per unit net health benefit ($353.72) compared with olaparib monotherapy ($260.57). This suggests that while the combination may offer similar clinical outcomes, the economic burden is higher.
Toxicity Profiles in Upfront vs. Relapsed Settings
Interestingly, the study found that upfront PARP inhibitor regimens had lower toxicity scores than the regimens used at relapse. This may influence treatment decisions, particularly in patients where minimizing toxicity is a priority.
Implications for Treatment Decisions
The findings suggest that the choice of PARP inhibitor regimen in BRCA-mutated ovarian cancer patients should consider not only efficacy and toxicity but also costs. The authors conclude that combining PARP inhibitor regimens may not be cost-effective in the upfront setting. Clinicians should weigh the potential benefits against the increased costs when making treatment decisions for these patients.
