Newly diagnosed ovarian cancer: Which first-line treatment?

Poly ADP-Ribose Polymerase (PARP) inhibitors (PARPi) were firstly licensed for maintenance treatment in recurrent, platinum-sensitive, platinum responsive epithelial ovarian cancer patients, harboring or not a BRCA mutation. Three new phase III trials - PAOLA1/ENGOT-OV25, PRIMA/ENGOT-OV26 and VELIA/GOG-3005 - showed that there is a role for PARPi also in first-line setting, as maintenance or in combination with platinum based chemotherapy. Nevertheless the published trials raised several questions on what is the best treatment according to the molecular and clinical characteristics of the treated patients. This review focuses on the published data in order to inform clinician decision making on what could be the best sequence or combination of treatments for the three molecular defined cohorts of patients emerging in the first line trials (the carriers of a BRCA mutation (BRCAmut), those with a deficiency in homologous recombination system (HRd) and those with a proficient homologous recombination system (HRp)) and put the newly published data in the context of the ovarian cancer treatment landscape.