SynthesisFrontiers in oncology2026
Efficacy and safety of PARP inhibitors in older patients with advanced ovarian cancer: a systematic review and network meta-analysis.
Synthesis in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
Background: Older adults with advanced ovarian cancer (AOC) are underrepresented in randomized clinical trials (RCTs), limiting age-specific evidence on poly(ADP-ribose) polymerase inhibitors (PARPi). This network meta-analysis (NMA) compares PARPi efficacy and safety across age groups. Methods: We searched PubMed, Embase, and Web of Science until January 20, 2026, for RCTs evaluating PARPi in adults with AOC. Screening and extraction utilized Nested Knowledge. Risk of bias was assessed via RoB 2. A frequentist NMA estimated hazard ratios (HR) and odds ratios (OR) with 95% CIs. Treatment rankings utilized P-scores. Results: A total of 13 RCTs were included. In younger patients, olaparib (HR, 0.32; 95% CI, 0.19-0.54), rucaparib (HR, 0.33; 95% CI, 0.16-0.69), and niraparib (HR, 0.53; 95% CI, 0.38-0.74) significantly improved progression-free survival (PFS) compared with placebo or chemotherapy. Similar benefits were observed in older patients (≥65 years), with significant PFS improvements for olaparib (HR, 0.44; 95% CI, 0.25-0.77), rucaparib (HR, 0.43; 95% CI, 0.19-0.97), and niraparib (HR, 0.56; 95% CI, 0.38-0.83). In the overall adult population, senaparib, veliparib, and olaparib were associated with significant improvements in PFS. Regarding safety, niraparib was associated with increased odds of treatment-emergent adverse events (OR, 3.80; 95% CI, 1.72-8.39), while both niraparib and olaparib were associated with higher risks of grade ≥3 anaemia and other hematologic toxicities. Placebo or chemotherapy ranked most favourably across most safety outcomes. Substantial heterogeneity was observed across several efficacy networks, and most treatment comparisons relied on indirect evidence. Conclusions: PARP inhibitors improved progression-free survival across age groups, including patients aged ≥65 years. However, treatment was associated with increased hematologic and gastrointestinal toxicities. Further studies should assess geriatric outcomes, long-term safety, and patient-reported outcomes.
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