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Lancet Oncol. 2019 May;20(5):636-648. doi: 10.1016/S1470-2045(19)30029-4. Epub 2019 Apr 1.

Niraparib monotherapy for late-line treatment of ovarian cancer (QUADRA): a multicentre, open-label, single-arm, phase 2 trial.

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Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Electronic address:
Department of Obstetrics and Gynecology, Duke Cancer Institute, Duke University Health System, Durham, NC, USA.
Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School, Minneapolis, MN, USA.
Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX, USA.
Division of Gynecologic Oncology, Texas Oncology-Fort Worth, Fort Worth, TX, USA.
Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA.
Department of Oncology, Mayo Clinic, Rochester, MN, USA.
Department of Obstetrics, Gynecology, and Reproductive Sciences, Smilow Cancer Hospital at Yale and Yale University, New Haven, CT, USA.
Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, RI, USA.
Division of Medical Oncology and Hematology, University Health Network and Princess Margaret Cancer Centre, Toronto, ON, Canada.
Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA.
Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford, CA, USA.
Division of Gynecologic Oncology, Sutter Health, San Francisco, CA, USA.
Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Division of Biostatistics, Tesaro, Waltham, MA, USA.
Division of Translational Research & Development, Tesaro, Waltham, MA, USA.
Division of Clinical Research, Tesaro, Waltham, MA, USA.
Division of Gynecologic Oncology, Harvard Medical School, Boston, MA, USA.
Division of Gynecologic Oncology, Arizona Oncology (US Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine at St Joseph's Hospital, Phoenix, AZ, USA.

Erratum in



Late-line treatment options for patients with ovarian cancer are few, with the proportion of patients achieving an overall response typically less than 10%, and median overall survival after third-line therapy of 5-9 months. In this study (QUADRA), we investigated the activity of niraparib monotherapy as the fourth or later line of therapy.


QUADRA was a multicentre, open-label, single-arm, phase 2 study that evaluated the safety and activity of niraparib in adult patients (≥18 years) with relapsed, high-grade serous (grade 2 or 3) epithelial ovarian, fallopian tube, or primary peritoneal cancer who had been treated with three or more previous chemotherapy regimens. The study was done in the USA and Canada, and 56 sites screened patients (50 sites treated at least one patient). Patients received oral niraparib 300 mg once daily continuously, beginning on day 1 and every cycle (28 days) thereafter until disease progression. The primary objective was the proportion of patients achieving an investigator-assessed confirmed overall response in patients with homologous recombination deficiency (HRD)-positive tumours (including patients with BRCA and without BRCA mutations) sensitive to their last platinum-based therapy who had received three or four previous anticancer therapy regimens (primary efficacy population). Efficacy analyses were additionally done in all dosed patients with measurable disease at baseline.


Between April 1, 2015 and Nov 1, 2017, we screened 729 patients for eligibility and enrolled 463 patients, who were initiated on niraparib therapy. At the time of database lock (April 11, 2018), enrolment had closed and the study was ongoing, with 21 patients still on treatment. Patients had received a median of four (IQR 3-5) previous lines of therapy, and the median follow-up for overall survival was 12·2 months (IQR 3·7-22·1). 151 (33%) of 463 patients were resistant and 161 (35%) of 463 patients were refractory to the last administered platinum therapy. 13 (28%) of 47 patients in the primary efficacy population achieved an overall response according to RECIST (95% CI 15·6-42·6; one-sided p=0·00053). The most common drug-related grade 3 or worse treatment-emergent adverse events were anaemia (113 [24%] of 463 patients) and thrombocytopenia (95 [21%] of 463 patients). The most common treatment-emergent serious adverse events were small intestinal obstruction (34 [7%] of 463 patients), thrombocytopenia (34 [7%] of 463 patients), and vomiting (27 [6%] of 463 patients). One death due to gastric haemorrhage was considered treatment related.


We observed clinically relevant activity of niraparib among women with heavily pretreated ovarian cancer, especially in patients with HRD-positive platinum-sensitive disease, which includes not only patients with a BRCA mutation but also a population with BRCA wild-type disease. We identified no new safety signals. Our data support expansion of the treatment indication for poly(ADP-ribose) polymerase inhibitors to include patients with HRD-positive ovarian cancer beyond those with BRCA mutations.



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