Objective:

To compare the efficacy and safety of PARP inhibitors across different age groups in patients with advanced ovarian cancer.

Approach:

• Study Design: A systematic review and network meta-analysis (NMA) of randomized clinical trials (RCTs) evaluating PARP inhibitors in adults with advanced ovarian cancer.
• Data Sources: PubMed, Embase, and Web of Science were searched until January 20, 2026.
• Risk Assessment: Risk of bias was assessed using RoB 2.
• Statistical Analysis: A frequentist NMA estimated hazard ratios (HR) and odds ratios (OR) with 95% confidence intervals (CIs).

Key Findings:

• Olaparib, rucaparib, and niraparib significantly improved progression-free survival (PFS) in both younger and older patients (HR for olaparib, 0.44; 95% CI, 0.25–0.77; HR for rucaparib, 0.43; 95% CI, 0.19–0.97; HR for niraparib, 0.56; 95% CI, 0.38–0.83).
• Niraparib was associated with increased odds of treatment-emergent adverse events (OR, 3.80; 95% CI, 1.72–8.39) and higher risks of grade ≥3 anaemia and other hematologic toxicities.

Interpretation:

PARP inhibitors improve PFS across age groups, including those aged ≥65 years, but are associated with increased hematologic and gastrointestinal toxicities.

Limitations:

• Substantial heterogeneity was observed across efficacy networks.
• Most treatment comparisons relied on indirect evidence.

Conclusion:

Further studies are needed to assess geriatric outcomes, long-term safety, and patient-reported outcomes.