Giuseppe Caruso, Medical Consultant at The European Institute of Oncology, shared on LinkedIn:
“Neoadjuvant PARPis in advanced ovarian cancer
Three trials – very recently published in 2026 – tested PARPi in the neoadjuvant setting for advanced ovarian cancer, with two different strategies:
- OPAL-C (Gynecol Oncol): niraparib instead of chemotherapy in HRD+ patients. Response rate 32% vs 71% with carboplatin–paclitaxel. Closed early for futility.
- NUVOLA (IJGC): intermittent olaparib added to weekly chemotherapy in BRCAm patients. pCR 8.6%. Primary endpoint not met.
- NANT (Lancet Oncol): niraparib alone for 2 cycles in HRD+ patients. Response rate 63% in evaluable patients and 80% R0, the most encouraging signal. But it is single-arm, 28% of patients were not evaluable, and benefit was lower in BRCAwt.
My take: we had great enthusiasm for PARPi, and rightly so in maintenance for BRCAm/HRD+. But they are not the right choice for every patient, and the hope of replacing/tailoring the carboplatin-paclitaxel milestone before cytoreductive surgery has clearly cooled.
Next up: now ADCs are moving into earlier settings, in the neoadjuvant as well. Exciting, but I would be cautious and learn from history.”
