Abstract
Introduction
Niraparib and bevacizumab are two principal maintenance therapies for newly diagnosed advanced ovarian cancer (AOC) patients with BRCA wild-type (BRCAwt) status, regardless of homologous recombination deficiency (HRD). In China, however, a considerable proportion of BRCAwt patients have unknown or untested HRD status, complicating treatment selection.
Methods
To evaluate and compare the efficacy of niraparib and bevacizumab as maintenance therapy for BRCAwt AOC, we conducted a retrospective cohort study using real-world clinical data. Descriptive statistics were used to summarize clinical and demographic characteristics. Progression-free survival (PFS) was estimated using Kaplan–Meier analysis and compared using a stratified Cox proportional hazards model. A multivariable Cox regression was performed to adjust for potential confounding variables. Exploratory subgroup analyses were conducted, and propensity score matching (PSM) was applied as a sensitivity analysis.
Results
A total of 94 patients were included, with 51 receiving niraparib and 43 receiving bevacizumab. The median PFS was not reached in the niraparib group versus 13.77 months (95% CI, 4.12–23.41) in the bevacizumab group (HR = 0.240, 95% CI, 0.128–0.451; P < .001). After covariate adjustment, the median PFS was 19.55 months (95% CI, 9.40–NA) with niraparib and 8.64 months (95% CI, 4.53–NA) with bevacizumab, with an adjusted HR of 0.282 (95% CI, 0.136–0.587; P = .001). In the PSM sensitivity analysis, the median PFS was not reached (95% CI, 19.55–NR) in the niraparib group and was 18.33 months (95% CI, 8.90-25.26) in the bevacizumab group (HR = 0.360, 95% CI, 0.176–0.736; P = .005).
Conclusion
This analysis suggests that niraparib may provide a progression-free survival advantage compared with bevacizumab in BRCAwt AOC patients, with both regimens appearing to be generally well tolerated in the real-world setting. These findings offer preliminary reference value for maintenance treatment selection in patients with newly diagnosed BRCAwt AOC.
Introduction
Ovarian cancer is a leading cause of cancer-related deaths among women worldwide. 1 In 2022, the incidence and mortality rates of ovarian cancer in China were 5.68/100 000 and 2.64/100 000, respectively.2,3 The standard treatment option for newly diagnosed advanced ovarian cancer includes surgical cytoreduction and platinum-based chemotherapy. 4 Despite an initial response to the primary treatment, 70% of women with advanced-stage epithelial ovarian cancer (EOC) experience relapse within 3 years after diagnosis, and the 5-year survival rate remains below 40%.5,6
Bevacizumab, a monoclonal antibody, binds to all isoforms of the vascular endothelial growth factor (VEGF)-receptor ligand VEGF-A, improving survival in women with ovarian cancer. In 2018, based on the phase III GOG-0218 and ICON-7 trials, bevacizumab was approved as a first-line maintenance therapy for patients with newly diagnosed advanced ovarian cancer who underwent surgery and received bevacizumab-containing platinum-based chemotherapy in the United States.3,7 However, the National Medical Products Administration (NMPA) of China did not approve bevacizumab for ovarian cancer treatment until November 2021. Although studies have demonstrated a significant benefit in progression-free survival (PFS), the addition of bevacizumab to standard chemotherapy in newly diagnosed ovarian cancer cases did not improve overall survival, except in individuals at high risk of relapse.8,9
The emergence of poly(adenosine diphosphate–ribose)polymerase (PARP) inhibitors over the past decade has fostered another major change in the landscape of ovarian cancer treatment. The phase III SOLO1 trial demonstrated marked PFS benefits for olaparib maintenance therapy in newly diagnosed advanced ovarian cancer cases with BRCA mutations; subsequently, the PRIMA trial showed that niraparib provided a PFS benefit regardless of biomarker status.10,11 Based on the above findings, the NMPA of China successively approved olaparib and niraparib for first-line maintenance (1L-M) treatment in patients with BRCA mutation and in all comers in 2019 and 2020, respectively.
The National Comprehensive Cancer Network (NCCN) and the European Society for Medical Oncology (ESMO) guidelines recommend maintenance regimens for newly diagnosed advanced ovarian cancer cases based on biomarker status. Maintenance treatment with PARP inhibitors (PARPis), with or without bevacizumab, is recommended for cases with BRCA1/2 mutation or BRCA1/2 wild-type (BRCAwt) with homologous recombination deficiency (HRD) positivity. In patients without HRD, either bevacizumab or niraparib monotherapy may be considered.5,12 With the growing emphasis on precision medicine, BRCA1/2 genetic testing is increasingly recognized as an essential component in the clinical management of ovarian cancer, as it plays a critical role in guiding maintenance strategies, informing therapeutic selection, and predicting prognosis and survival outcomes. 13 However, there is currently no uniform standard for HRD testing in China as well as no companion diagnostic kit approved by the NMPA, which limits the choice by gynecologic oncologists of maintenance therapy based on HRD status. 14 Only niraparib and bevacizumab monotherapies are currently approved as 1L-M treatment options for ovarian cancer with BRCAwt but unknown homologous recombination status in China. However, no trials have compared the efficacy or tolerability of these two options. Therefore, a retrospective cohort study was conducted to directly compare the clinical characteristics, effectiveness, and tolerability of maintenance therapy with niraparib versus bevacizumab in real-world BRCAwt cases with newly diagnosed advanced ovarian cancer (AOC).
Methods
Patients and Study Design
This retrospective cohort study was conducted at our hospital. Inclusion criteria were as follows: (1) age ≥18 years at diagnosis; (2) histologically confirmed International Federation of Gynecology and Obstetrics (FIGO) stage III or IV epithelial ovarian cancer, fallopian tube cancer, or primary peritoneal cancer; (3) no germline pathogenic variants in BRCA1/2; (4) receipt of platinum-based chemotherapy followed by Chemotherapy Response Score (CRS) assessment showing complete or partial response; (5) treatment with either niraparib or bevacizumab as first-line maintenance therapy from July 1, 2020 to December 31, 2021; (6) Eastern Cooperative Oncology Cohort performance status of 0 or 1. Exclusion criteria were: (1) incomplete or unknown important clinical information; (2) irregular follow-up or loss to follow-up. Patients were enrolled regardless of whether bevacizumab was included in their chemotherapy regimen. Baseline characteristics included age, FIGO stage, ascites, treatment with neoadjuvant chemotherapy, outcome of CRS, first - line treatment response, and CA-125 ELIMination rate constant (KELIM) calculated during neoadjuvant chemotherapy to assess the tumor's intrinsic chemosensitivity (http://www.biomarker - kinetics.org/CA - 125 - neo). 15 HRD testing was not routinely performed during the study period; therefore, HRD status was not available for analysis. The reporting of this study conforms to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. 16 In accordance with the Declaration of Helsinki, the present study was approved by the Ethics Committee of Zhejiang Cancer Hospital (IRB-2023-1063) in Hangzhou, Zhejiang, China on the November 29, 2023. As the research was retrospective and involved only de-identified data, additional informed consent was waived by the Institutional Review Board.
Treatment
Niraparib was administered orally at an individualized starting dose (ISD): cases with body weight <77 kg and/or platelet count <150 × 103/μL at baseline received niraparib at 200 mg once daily (QD); the remaining patients received niraparib at 300 mg QD. All patients were expected to be treated for 36 months. Bevacizumab (7.5 mg/kg body weight) was administered concurrently every 3 weeks for 5 or 6 cycles of standard chemotherapy and continued for 12 additional cycles. Treatment was performed until completion of the full course, disease progression, or intolerable toxic effects.
Efficacy and Tolerability Assessments
PFS was defined as the time from the last chemotherapy to investigator-assessed disease progression or death. Tumors were assessed by computed tomography or magnetic resonance imaging or by determining serum cancer antigen 125 (CA125) levels in combination with clinical symptoms. Progression was determined based on clinical judgment, typically supported by at least one piece of radiographic evidence of disease enlargement or new lesions, or by a confirmed rise in CA125 accompanied by worsening symptoms. The frequency of imaging assessments was not prespecified.
Tolerability was monitored by recording treatment interruptions, dose adjustments, and treatment discontinuations. Adverse events were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
Statistical Analysis
Descriptive statistics were employed to evaluate clinicodemographic characteristics. Progression-free survival (PFS) was analyzed using Kaplan-Meier Analysis between the two cohorts, and differences were assessed using two-sided tests with a significance level of 0.05. A stratified Cox proportional hazards model was applied to estimate the hazard ratio (HR) and 95% confidence interval (CI) between the treatment groups. Stratification was performed to account for potential heterogeneity across strata and to ensure a more robust estimation of the treatment effect. Furthermore, a multivariable Cox regression analysis was performed to adjust for potential confounding variables, including median age (≤60 vs >60 years), FIGO stage (III vs IV), outcome of cytoreductive surgery (R1/R2 vs R0), presence of ascites (No vs Yes), receipt of neoadjuvant chemotherapy (Yes vs No), response after first-line chemotherapy (Complete Response [CR] vs Partial Response [PR]), and KELIM value (KELIM <1 vs KELIM ≥1). The proportional hazards assumption was not formally assessed in this retrospective analysis. An exploratory subgroup analysis was conducted to assess potential differences in the treatment effects across patient subgroups.
To further address the baseline imbalances between the niraparib and bevacizumab cohorts, propensity score matching (PSM) was performed as a sensitivity analysis. Propensity scores were calculated using variables that showed significant distribution differences in the univariable comparison, specifically FIGO stage (III vs IV) and response to first-line chemotherapy (CR vs PR). A 1:1 nearest-neighbor matching algorithm without replacement was applied to obtain comparable sample sizes and achieve balanced distributions of these key clinical characteristics between groups. After matching, PFS analyses were repeated in the matched cohort. All statistical analyses were conducted using SAS version 9.4 (SAS Institute, Cary, NC).
Results
Patients
Between January 2020 and December 2021, a total of 207 patients were screened, and 94 patients met the eligibility criteria and were included: 51 receiving niraparib and 43 receiving bevacizumab. The study flowchart is shown in Figure 1.
Study flowchart.
The baseline patient characteristics are shown in Table 1 and were not completely balanced between the two cohorts. The bevacizumab cohort showed a slightly higher risk of relapse than the niraparib cohort, with higher rates of stage IV cases (53.49% vs 27.45%, P = .010), cytoreductive surgery (30.95% vs 12.24%, P = .029), neoadjuvant chemotherapy (53.49% vs 37.25%, P = .115), ascites (67.44% vs 50.98%, P = .107), and partial response after chemotherapy (40.48% vs 9.80%, P = .001).
Patients’ Characteristics (N = 94).
3 cases were missing.
1 case were missing.
10 cases were missing.
Efficacy
At the cutoff date (March 31, 2023), the median follow-up time estimated by the reverse Kaplan–Meier was 27.61 months (95% Confidence Interval [CI], 26.04–30.39) in the niraparib cohort and 24.48 months (95% CI, 19.00–NA) in the bevacizumab cohort. A total of 35 (68.6%) and 14 (32.6%) patients were still receiving niraparib or bevacizumab by the cutoff date, respectively. The median PFS was not reached in the niraparib group versus 13.77(95% CI 4.12–23.41) months in the bevacizumab group (Hazard Ratio [HR] = 0.240, 95% CI, 0.128–0.451; P < .001). The Kaplan–Meier probabilities of PFS in the niraparib cohort were 82.2% and 73.0% at 12 and 24 months, respectively; compared with 72.1% and 46.4% in the bevacizumab cohort (Figure 2).
Kaplan-Meier curves showing progression-free survival (PFS) in the niraparib and bevacizumab cohorts.
After adjusting for the covariates (median age, FIGO stage, outcome of cytoreductive surgery, presence of ascites, receipt of neoadjuvant chemotherapy, response after first-line chemotherapy, and KELIM value) in the Kaplan–Meier analysis, the median PFS was 19.55 months (95% CI, 9.40–NA) with niraparib, versus 8.64 months (95% CI, 4.53–NA) with bevacizumab (Figure 3). After adjusting for the covariates in the multivariate cox regression model, the adjusted-HR for niraparib versus bevacizumab was 0.282 (95%CI 0.136–0.587, P = .001) (Figure 4, Supplementary Table 2).
Kaplan–Meier curves for PFS after adjustment for baseline covariates.
Forest plot of multivariate Cox regression results for disease progression.
The results of the exploratory subgroup analysis indicate that across multiple subgroups such as age, FIGO stage, outcome of cytoreductive surgery, presence of ascites, and receipt of neoadjuvant chemotherapy, the bevacizumab group consistently exhibited a PFS benefit when compared to the niraparib group. All subgroup HRs were less than 1, and statistical significance was achieved in most subgroups. Notably, the advantage of the bevacizumab group was particularly pronounced in patients with FIGO Stage IV disease (HR = 0.170, 95% CI, 0.033–0.878) and those with R1/R2 residual disease (HR = 0.074, 95% CI, 0.009–0.587) (Figure 5).
Subgroup forest plot for treatment effect on PFS (niraparib vs bevacizumab).
A PSM sensitivity analysis was conducted to address potential selection bias, yielding an additional 1:1 matched cohort of 33 patients per treatment group. The baseline characteristics after matching are presented in Supplementary Table 3. In the PSM cohort, the median PFS was not reached (95% CI: 19.55–NR) in the niraparib group, whereas it was 18.33 months (95% CI: 8.90–25.26) in the bevacizumab group (HR = 0.360, 95% CI: 0.176–0.736; P = .005) (Supplementary Figure 1). The trend of the treatment effect was consistent with the results of the primary multivariate Cox analysis, which corroborated the robustness of the overall findings.
Tolerability
According to the individual starting dose criteria, all patients in the niraparib cohort were administered 200 mg orally once daily because of low body weight (<77 kg). Patients in the bevacizumab cohort received bevacizumab at 7.5 mg/kg every 21 days, with a median of 13 cycles administered. Dose reduction occurred in 68.6% of patients administered niraparib. The treatment discontinuation rates were 3.9% (2/51) in the niraparib cohort (due to hematological toxicities and gastrointestinal reactions) and 7% (3/43) in the bevacizumab cohort (due to ileus, financial concerns, and patient's request). Patients with grade 1–2 adverse events received symptomatic treatment, and dose adjustments were made as needed based on clinical evaluation. Grade ≥3 adverse events were not observed in the bevacizumab cohort. In the niraparib cohort, safety data were limited by the retrospective design.
Discussion
This retrospective study examined the efficacy of niraparib versus bevacizumab as first-line maintenance therapy. The findings showed that among BRCAwt patients, and across diverse baseline characteristics, niraparib exhibited a tendency towards a more significant PFS benefit when compared to bevacizumab. The numerically superior efficacy of niraparib observed before adjustment may be partly attributed to imbalances in baseline characteristics between the two cohorts. Specifically, the bevacizumab cohort included a greater proportion of patients with stage IV disease, R1/R2 resection status, and partial response after chemotherapy, which could reflect clinical experts’ treatment preferences. 17 Moreover, these characteristics may be independently associated with a poor prognosis and could potentially lead to a downward bias in the PFS results of the Bevacizumab group. After adjusting for the covariates in the multivariate Cox regression model, the adjusted-HR for niraparib versus bevacizumab was 0.282 (95% CI 0.136–0.587, P = .001), suggesting that the association remained statistically significant.
However, in this study, bevacizumab did not demonstrate a clear advantage over niraparib in patients considered at high risk of recurrence. Even among patients with stage IV disease, residual lesions, or ascites, niraparib was associated with a more favorable progression free survival outcome compared with bevacizumab.
Two pivotal factors may contribute to this observed benefit trend for niraparib. Firstly, this study did not evaluate the HRD status. The disparities in HRD status among patients might have affected the observed differences between the two groups to a certain degree. Specifically, prior studies have demonstrated that 25% of patients in the BRCAwt group tested positive for HRD, 18 and previous research has suggested that niraparib exerts a significant therapeutic impact on HRD-positive patients.11,19 In the PRIME study, mPFS was 24.8 months in the non-gBRCA mutations/HRD population, versus 14.0 months in the homologous recombination- proficiency (HRP) population. 19 HRD may be the primary factor responsible for the long survival benefit observed in BRCAwt patients. In contrast, in the subset of patients with HRR mutations in GOG-0218, extended bevacizumab treatment resulted in no statistically significant prolongation of PFS. 20 The PRIMA/ENGOT - OV26/GOG - 3012 trial indicated that in the HRD and homologous recombination - normal populations, the OS hazard ratios were 0.95 (95% CI 0.70–1.29) and 0.93 (95% CI 0.69–1.26), respectively. 21 In the HRD population, the probability of 5-year PFS for patients treated with niraparib was twice that of those treated with placebo (overall population: niraparib 22%, placebo 12%; HRD population: niraparib 35%, placebo 16%). However, there was no significant difference in overall survival among treatment groups in newly diagnosed advanced ovarian cancer patients with a high risk of recurrence (HR = 1.01, 95% CI 0.84–1.23). Besides, based on the OS results from the PAOLA-1/ENGOT-ov25 trial, patients with HRD-positive advanced ovarian cancer should prioritize olaparib plus bevacizumab maintenance therapy. 22 This combination significantly prolonged OS (HR = 0.62, 95% CI 0.45-0.85; 5-year OS rate, 65.5% vs 48.4%), and the updated 5-year progression-free survival (PFS) data also demonstrated a substantial advantage (HR = 0.41, 95% CI 0.32–0.54; 5-year PFS rate, 46.1% vs 19.2%). However, for patients with unknown or HRD-negative status, the benefit of combination therapy observed in the PAOLA-1 trial is relatively limited. In this patient population, our study provides valuable real-world data directly comparing the efficacy of niraparib monotherapy versus bevacizumab monotherapy. Therefore, our findings serve as a reference for clinicians when selecting the optimal single-agent maintenance strategy for patients with unknown HRD status, or those for whom combination treatment is not feasible or indicated.
Furthermore, despite previous findings suggesting that bevacizumab is more effective in patients at high risk of recurrence, niraparib also appears to be more effective in such patients. In a post hoc analysis of patients in PRIMA, hazard ratios for progression (niraparib vs placebo) were 0.67 and 0.57 in the primary debulking surgery (PDS) and neoadjuvant chemotherapy/interval debulking surgery (NACT/IDS) subgroups, respectively. In patients with no visible residual disease (NVRD) or visible residual disease (VRD) following NACT/IDS, hazard ratios were 0.65 and 0.41, respectively. 23 Similarly, in the PRIME study, HRs were 0.44 (95% CI 0.32-0.61, P < .0001) and 0.27 (0.10-0.72, P = .0056) in the satisfactory debulking (R0 + R1) and unsatisfactory debulking (R2) subgroups, respectively. 24 The above results suggest that niraparib also confers a greater survival benefit in patients at high risk of recurrence, which may explain the lack of advantage for bevacizumab over niraparib among these patients.
The PSM was carried out as a sensitivity analysis to further address potential bias arising from baseline imbalances. The HR obtained from the matched cohort was 0.36, in line with the trend of the primary multivariable Cox analysis, suggesting that the observed treatment effect remained robust after balancing key clinical covariates. These findings corroborate the reliability and clinical relevance of our results.
Patient's tolerance and efficacy are equally important for maintenance therapy and are related to drug dosage, toxicity, and administration mode. In this study, all patients in the niraparib cohort received an ISD, whereas 35% and 100% of patients in the PRIMA and PRIME studies, respectively, received ISD.11,19 Given that most Chinese female patients have a body weight of ≤77 kg, the ISD approach led to a starting dose of 200 mg, which was associated with better tolerance and a higher completion rate of maintenance therapy cycles. Similarly, the bevacizumab dosage used in this study was 7.5 mg/kg, also consistent with the smaller body size of Chinese patients. The rate of treatment discontinuation related to adverse reactions with niraparib in this study was lower than that reported in the PRIME study: 3.3% versus 6.7%. 19 As for the bevacizumab cohort, although the overall discontinuation rate was 7%, only 2.3% was attributed to adverse reactions, which was also lower than the 6% reported in the PAOLA1 study. 25 We speculate that because of intensive follow-up and flexible management of adverse effects, the tolerance to niraparib or bevacizumab could be better in the real-world setting. For instance, in Chinese clinical practice, supportive treatments such as Caffeic Acid Tablets for Thrombocytopenia and certain Chinese patent medicines are commonly used to alleviate niraparib-induced thrombocytopenia, often with favorable outcomes. 26 In addition, once-daily oral niraparib is not only more convenient than bevacizumab administration that requires intravenous injection, 27 but also more economical, with fewer hospital visits, lower medical expenses and reduced time costs. 25
This study had certain limitations. Firstly, this was a single-center study with a relatively small sample size, which may limit the external generalizability of our results. Secondly, due to the high cost of homologous recombination deficiency (HRD) testing, lack of insurance coverage, and the absence of standardized testing protocols in China, most patients opted for BRCA testing only. As a result, subgroup analysis of efficacy and tolerability based on HRD status could not be examined. As HRD positivity is known to predict enhanced sensitivity to PARP inhibitors such as niraparib, undiagnosed HRD as an unmeasured confounding factor could potentially bias the results in favor of niraparib. However, the absence of routine HRD testing reflects real-world clinical practice in many settings, particularly in regions where access to comprehensive genomic profiling remains limited. Besides, the proportional hazards assumption of the Cox models was not formally evaluated, which may introduce uncertainty in the HR estimates. Finally, as a retrospective analysis, we were unable to collect detailed adverse events and patient-reported outcomes to enrich the safety profile. Given the inherent limitations of the retrospective design and the potential influence of unmeasured confounders, these findings should be interpreted with appropriate caution. Nevertheless, the consistency of the observed trends underscores the clinical relevance of our results and highlights the need for further validation in larger, prospective cohorts.
Despite these limitations, this study represents, to our knowledge, the first attempt to compare the efficacy of niraparib versus bevacizumab as monotherapy maintenance treatments for newly diagnosed AOC patients in China. While our findings broadly align with existing evidence supporting the use of PARP inhibitors in the maintenance setting, they further suggest that niraparib may provide a PFS advantage over bevacizumab in a real-world population. These results suggest that niraparib may be considered a preferred option over bevacizumab for maintenance therapy, particularly in countries and regions where HRD testing is not widely accessible. We plan to continue following up with this study population to generate more robust data on the efficacy of subsequent treatments, long-term tolerability, overall survival, and other related outcomes.
Conclusion
In this real-world retrospective cohort study, maintenance therapy with the PARP inhibitor niraparib was evaluated in comparison with bevacizumab among patients newly diagnosed with BRCAwt AOC. The observed data indicated a potential PFS benefit with niraparib, including among patients at higher risk of recurrence. Both therapeutic approaches appeared to be generally well tolerated. Given the current landscape of genetic testing in China, this study may provide valuable preliminary insights and serve as a reference for the selection of maintenance treatment options for newly diagnosed BRCAwt AOC patients in clinical practice.
Supplemental Material
sj-docx-1-tct-10.1177_15330338261416162 - Supplemental material for Comparison of Different Maintenance Treatment Options for Newly Diagnosed BRCAwt Advanced Ovarian Cancer: A Retrospective Cohort Analysis
Supplemental material, sj-docx-1-tct-10.1177_15330338261416162 for Comparison of Different Maintenance Treatment Options for Newly Diagnosed BRCAwt Advanced Ovarian Cancer: A Retrospective Cohort Analysis by Xi Chen, Chenyan Fang, Yanglong Guo and Yingli Zhang in Technology in Cancer Research & Treatment
Supplemental Material
sj-docx-2-tct-10.1177_15330338261416162 - Supplemental material for Comparison of Different Maintenance Treatment Options for Newly Diagnosed BRCAwt Advanced Ovarian Cancer: A Retrospective Cohort Analysis
Supplemental material, sj-docx-2-tct-10.1177_15330338261416162 for Comparison of Different Maintenance Treatment Options for Newly Diagnosed BRCAwt Advanced Ovarian Cancer: A Retrospective Cohort Analysis by Xi Chen, Chenyan Fang, Yanglong Guo and Yingli Zhang in Technology in Cancer Research & Treatment
Supplemental Material
sj-docx-3-tct-10.1177_15330338261416162 - Supplemental material for Comparison of Different Maintenance Treatment Options for Newly Diagnosed BRCAwt Advanced Ovarian Cancer: A Retrospective Cohort Analysis
Supplemental material, sj-docx-3-tct-10.1177_15330338261416162 for Comparison of Different Maintenance Treatment Options for Newly Diagnosed BRCAwt Advanced Ovarian Cancer: A Retrospective Cohort Analysis by Xi Chen, Chenyan Fang, Yanglong Guo and Yingli Zhang in Technology in Cancer Research & Treatment
Supplemental Material
sj-jpg-4-tct-10.1177_15330338261416162 - Supplemental material for Comparison of Different Maintenance Treatment Options for Newly Diagnosed BRCAwt Advanced Ovarian Cancer: A Retrospective Cohort Analysis
Supplemental material, sj-jpg-4-tct-10.1177_15330338261416162 for Comparison of Different Maintenance Treatment Options for Newly Diagnosed BRCAwt Advanced Ovarian Cancer: A Retrospective Cohort Analysis by Xi Chen, Chenyan Fang, Yanglong Guo and Yingli Zhang in Technology in Cancer Research & Treatment
Footnotes
Ethics Approval and Consent to Participate
In accordance with the Declaration of Helsinki, the present study was approved by the Ethics Committee of Zhejiang Cancer Hospital (IRB-2023-1063) in Hangzhou, Zhejiang, China on the November 29, 2023. As the research was retrospective and involved only de-identified data, additional informed consent was waived by the Institutional Review Board.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by the Medical Health Science and Technology Project of Zhejiang Provincial Health Commission (Grant No. 2022KY081).
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Availability of Data and Materials
Data is provided within the manuscript or supplementary information files.
Supplemental Material
Supplemental material for this article is available online.
References
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