Frontline is platinum based chemo with or without bev.
Germline BRCA or HRD, negative-- Observation is ok, Niraparib cat 2A based on PRIMA. Also PRIME trial showed benefit in all comers ( stage III was included, therefore good risk patients). HR 0.72 with a 16 month versus 8 month PFS benefit in HRP versus placebo.
HRD positive BRCA WT PAOLA-1 data
In patients with advanced ovarian cancer receiving first-line standard therapy including bevacizumab, the addition of maintenance olaparib provided a significant progression-free survival benefit, which was substantial in patients with HRD-positive tumors, including those without a BRCA mutation
Germline or somatic BRCA mutations POSITIVE
Niraparib and olaparib are NCCN category 1 recommended options for those with germline or somatic BRCA1/2 mutations who are in complete or partial remission after surgery and platinum-based first-line chemotherapy
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