OBJECTIVES: Ovarian cancer is a serious, life-threatening and the second-most common gynecological cancer in the US. Poly ADP-ribose polymerase inhibitors (PARPi) is a new class of drugs for platinum sensitive recurrent ovarian cancer (PSROC) patients. As there are no head-to-head trials comparing the marketed PARPi – olaparib, rucaparib, and niraparib, a network meta-analysis (NMA) was conducted.

METHODS: A comprehensive systematic literature review was conducted using biomedical databases (Embase, Medline) and other sources (clinical trial registries, conferences) to identify phase-III RCTs published between January-2008 and April-2019. Clinical data across studies was extracted and qualitatively appraised by two independent reviewers. NMA was performed using the frequentist method of netmeta package of R program (version 3.6). The outcomes studied were progression free survival (PFS) and adverse events (AE), while Risk Ratio (RR) was used as the summary measure.

RESULTS: All PARPi showed significant improvement in PFS compared with placebo (p<0.05). Olaparib, rucaparib, niraparib showed improvement in PFS, from 6 months [RR 2.48 (95% CI 1.84 – 3.34)]; [RR 1.97 (95% CI 1.46 – 2.67)]; [RR 1.85 (95% CI 1.38 – 2.48)] to 24 months [RR 2.66 (95% CI 1.74 – 4.07)]; [RR 5.84 (95% CI 2.20 - 15.52)]; [RR 2.73 (95% CI 1.50 – 4.99)], respectively. RR for serious AEs [RR 2.22 (95% CI 1.07 – 4.60)]; [RR 1.98 (95% CI 1.25 – 3.14)]; [RR 1.99 (95% CI 1.36 – 2.91)] and treatment discontinuation due to AE [RR 0.51 (95% CI 0.29 – 0.88)]; [RR 0.51 (95% CI 0.36 – 0.72)]; [RR 0.49 (95% CI 0.35 – 0.68)] was similar in olaparib, rucaparib, niraparib, respectively.

CONCLUSIONS: Out of the 3 drugs of PARPi, rucaparib showed constant improvement in PFS, up to 24 months. All the drugs showed similar safety outcomes. The results show that rucaparib has the best benefit-risk profile for the treatment of PSROC patients.