Maintenance of PARP Inhibitor Rechallenge Plus Bevacizumab in Patients with Platinum-Sensitive, Recurrent Ovarian Cancer Previously Treated with a PARP Inhibitor (KGOG 3056/NIRVANA-R)

Poly(ADP-ribose) polymerase inhibitors (PARPi) have shown clinical benefit in prolonging progression-free survival (PFS) in ovarian cancer. However, the efficacy of subsequent chemotherapy after PARPi progression is limited. While modest benefits have been seen with PARPi rechallenge, the efficacy of rechallenging with PARPi in combination with bevacizumab remains unknown. NIRVANA-R, a phase 2 study, evaluated niraparib rechallenge with bevacizumab in 44 patients with platinum-sensitive recurrent ovarian cancer previously treated with PARPi. The estimated 6-month PFS rate, the primary endpoint, was 68% [95% confidence interval (CI): 55–85%]. Notably, higher 6-month PFS rates were observed in patients with a longer treatment-free interval after the penultimate chemotherapy and in those who achieved a complete response to the most recent chemotherapy. Median PFS was 11.5 months [95% CI: 7.9–not reached]. This is the first report of niraparib rechallenge with bevacizumab as maintenance therapy in this patient population. The combination showed promising efficacy, especially in patients who responded well to prior platinum-based chemotherapy.