- Design
- Multicentre, single-arm, phase 2 trial
- Population
- 67 women with HRD-positive stage III–IV high-grade ovarian cancer unsuitable for primary surgery
- Primary outcome
- Objective response rate; R0 resection rate
- Effect
- ORR 63% (47–76); R0 80% (64–91) of operated patients
The NANT trial in The Lancet Oncology (7 October) gave two 28-day cycles of oral niraparib, instead of chemotherapy, to 67 women at six Chinese hospitals with stage III–IV HRD-positive high-grade serous or endometrioid ovarian cancer unsuitable for primary debulking.
The response rate was 63% among 48 evaluable patients, and 32 of the 40 who had interval surgery (80%) achieved complete (R0) resection. Grade 3–4 thrombocytopenia affected 48%, leukopenia 19% and anaemia 18%; serious adverse events occurred in 28%, with no treatment-related deaths.
A chemotherapy-free route to surgery is attractive for frail patients, but this is single-arm phase 2 work, and the authors themselves say it needs randomised testing against carboplatin–paclitaxel. Platinum-based neoadjuvant chemotherapy remains the standard.
- Two cycles of niraparib gave a 63% response rate in HRD-positive disease
- 80% of those operated on achieved R0 resection
- Thrombocytopenia was common: grade 3–4 in nearly half
- Platinum–taxane neoadjuvant chemotherapy remains standard; this is investigational
Why it matters
It tests whether biomarker selection can replace chemotherapy before surgery in ovarian cancer.
Don't overread it
Single-arm phase 2, one population, with response and resection as surrogate endpoints.
The statistics, in plain English
The R0 rate of 80% (95% CI 64% to 91%) applies only to the 40 who reached surgery, not to all 67 enrolled, so the true proportion of all patients achieving R0 is lower.
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