- Design
- Single-arm, multicentre 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 and R0 resection rate
- Effect
- Response 63% (95% CI 47-76); R0 80% (64-91) of those operated
NANT, a single-arm phase 2 trial at six Chinese hospitals, gave two 28-day cycles of oral niraparib to 67 women with stage III-IV, homologous recombination deficiency (HRD)-positive high-grade serous or endometrioid ovarian cancer judged unlikely to have complete primary debulking. Published in The Lancet Oncology on 7 October 2026.
Of 48 women evaluable for response, 63% responded (95% CI 47 to 76). Of 40 who went on to interval surgery, 80% had no residual disease (R0). Grade 3-4 thrombocytopenia occurred in 48%, leukopenia in 19% and anaemia in 18%; there were no treatment-related deaths.
A chemotherapy-free bridge to surgery is attractive for women who tolerate platinum poorly. But the standard, platinum-taxane neoadjuvant chemotherapy, was not compared.
The authors themselves call this investigational, and platelet toxicity was substantial.
- Keep platinum-taxane neoadjuvant chemotherapy as standard for advanced ovarian cancer
- Test for HRD or BRCA status at diagnosis, since it guides PARP inhibitor use
- Monitor platelets closely during niraparib, particularly in the first cycles
- Consider trial referral for patients unsuitable for chemotherapy
Why it matters
Biomarker selection may one day allow a chemotherapy-free route to surgery for some women.
Don't overread it
Single-arm and phase 2; it cannot show niraparib is as good as standard chemotherapy.
The statistics, in plain English
Response and R0 rates have wide confidence intervals because numbers were small, and without a control arm there is no comparison with what chemotherapy would have achieved.
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