Oncology · 4 h ago
ASCO Updates PARP Inhibitor Recommendations for Ovarian Cancer
ASCO’s 2026.1.0 living guideline updates recommendations for PARP inhibitors (PARPis) in epithelial ovarian cancer, drawing on 79 publications, including 31 pivotal trials. It prioritizes maintenance treatment after first-line chemotherapy for selected patients and limits use in recurrent disease, while highlighting testing and safety considerations.
- Testing includes genetic assessment and, when BRCA-negative, HRD tumor testing.
- Frontline maintenance is prioritized for selected BRCA-mutated or HRD-positive disease.
- Recurrent-disease PARPi use is restricted; monitor for serious adverse events.
An ASCO Expert Panel updated its living guideline on PARP inhibitors in epithelial ovarian cancer using a systematic review of randomized trials and cohort studies. The evidence base included 79 publications: 18 studies of homologous recombination deficiency (HRD) assays and 31 pivotal trials assessing efficacy and safety. Frontline trials showed progression-free survival benefits; later-line treatment and recurrent maintenance trials reported potential overall survival disadvantages.
The guideline recommends genetic testing for all patients with newly diagnosed advanced disease and HRD tumor testing when BRCA testing is negative, using FDA-approved or prospectively validated companion diagnostic assays. For advanced disease, PARPi maintenance is prioritized in the first clinical remission. Monotherapy maintenance after response to platinum-based chemotherapy should be offered to patients with germline or somatic BRCA1/2 mutations or HRD-positive disease. Olaparib plus bevacizumab may be offered after first-line platinum chemotherapy plus bevacizumab for patients with BRCA1/2 mutations or HRD-positive disease.
PARPi maintenance is not recommended for early-stage disease or non-BRCA-mutated, HRD-negative tumors. In recurrent disease, maintenance should primarily be restricted to PARPi-naïve patients with BRCA1/2 mutations who respond to platinum chemotherapy; PARPi monotherapy for recurrent disease and combinations outside clinical trials are not recommended. The guideline also advises monitoring for myelodysplastic syndrome, acute myeloid leukemia and pulmonary complications. The full text was not available in the supplied source.
In practice
For patients with newly diagnosed advanced epithelial ovarian cancer, the guideline supports genetic testing for all and HRD tumor testing when BRCA-negative, then prioritizes PARPi maintenance in first clinical remission for selected BRCA1/2-mutated or HRD-positive disease. It allows olaparib plus bevacizumab in selected patients who received that first-line combination. It does not recommend maintenance for early-stage or non-BRCA-mutated, HRD-negative disease, and narrows recurrent maintenance mainly to PARPi-naïve patients with BRCA1/2 mutations. These are guideline recommendations summarized in an abstract; full-text details are unavailable here, and serious toxicities require monitoring.
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Journal of Clinical Oncology: PARP Inhibitors in the Management of Ovarian Cancer: ASCO Living Guideline, Version 2026.1.0 ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.