Epithelial ovarian cancer and brain metastases: might the status, PARP inhibitor administration, and surgical treatment impact the survival?

Objective: To evaluate disease characteristics and survival according to status, administration of poly-(ADP-ribose) polymerase inhibitors (PARPi), and surgery in patients with ovarian cancer and brain metastases.

Methods: This is a monocentric retrospective cohort of patients with ovarian cancer and brain metastases treated between 2000 and 2021. Data were collected by a retrospective review of medical records and analyzed according to: (1) mutation; (2) PARPi before and after brain metastases; (3) surgery for brain metastases.

Results: Eighty-five patients with ovarian cancer and brain metastasis and known status (31 mutated (m), 54 wild-type (wt)) were analyzed. Twenty-two patients had received PARPi before brain metastases diagnosis (11 m, 11 wt) and 12 after (8 m, 4 wt). Brain metastases occurred >1 year later in patients who had received previous PARPi. Survival was longer in the m group (median post-brain metastasis survival: m 23 months vs wt 8 months, p=0.0015). No differences were found based on status analyzing the population who did not receive PARPi after brain metastasis (median post-brain metastasis survival: m 8 months vs wt 8 months, p=0.31). In the m group, survival was worse in patients who had received previous PARPi (median post-brain metastasis survival: PARPi before, 7 months vs no-PARPi before, 24 months, p=0.003). If PARPi was administered after brain metastases, survival of the overall population improved (median post-brain metastasis survival: PARPi after, 46 months vs no-PARPi after, 8 months, p=0.00038).In cases of surgery for brain metastases, the prognosis seemed better (median post-brain metastasis survival: surgery 13 months vs no-surgery 8 months, p=0.036). Three variables were significantly associated with prolonged survival at multivariate analysis: mutation, multimodal treatment, and ≤1 previous chemotherapy line.

Conclusions: mutations might impact brain metastasis occurrence and lead to better outcomes. In a multimodal treatment, surgery seems to affect survival even in cases of extracranial disease. PARPi use should be considered as it seems to prolong survival if administered after brain metastasis.