Evaluating the role of secondary surgery and PARP inhibition in platinum-sensitive ovarian cancer relapse

Aim: To assess the benefit of secondary cytoreductive surgery (SCS) in patients with platinum-sensitive recurrent epithelial ovarian cancer (EOC), and to evaluate how survival outcomes are influenced by second-line PARP inhibitor maintenance therapy. Methods: This retrospective study included 52 patients with platinum-sensitive recurrent EOC treated at the National Cancer Institute of Aviano, Italy, between 2015 and 2022. Patients received either SCS followed by chemotherapy (SCS+CT group) or chemotherapy alone (CT-only group). The primary endpoints were progression-free survival (PFS) and post-recurrence survival (PRS). Secondary analyses explored the impact of second-line PARPi maintenance on survival outcomes within each treatment group. Results: Patients in the SCS+CT group experienced significantly longer PFS compared to those in the CT-only group (median 19.2 vs. 10.0 months, p=0.007). Among patients receiving PARPi maintenance, the benefit was even more pronounced: median PFS was 40.3 months in the SCS+CT group versus 21.9 months in the CT-only group (p=0.026). A non-significant trend toward improved PRS was observed in the SCS+CT group (48.3 vs. 36.0 months, p=0.23). PARPi maintenance was associated with longer PRS in both treatment arms (p=0.0056 for SCS+CT; p=0.033 for CT-only). Conclusions: In patients with platinum-sensitive recurrent EOC, SCS combined with chemotherapy significantly improves PFS, particularly when followed by second-line PARPi maintenance. These findings support the role of SCS in carefully selected patients and emphasize the synergistic effect of integrating surgical and molecularly targeted strategies.