{'fraction_non_alphanumeric': 0.025390625, 'fraction_numerical': 0.010416666666666666, 'mean_word_length': 5.540425531914893, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Niraparib in Recurrent Ovarian Cancer.

To the Editor: Mirza and colleagues (Dec. 1 issue)1 report encouraging results regarding niraparib maintenance therapy in patients with platinumsensitive, recurrent ovarian cancer. However, we advise caution. Increased progression-free survival with maintenance therapy among women with ovarian cancer has historically not resulted in increased overall survival.2,3 All patients with recurrent ovarian cancer will require subsequent therapy at relapse. Niraparib may induce cross-resistance to this chemotherapy, making recurrent disease more refractory. Data are lacking on progressionfree survival with subsequent therapy and on overall survival to confirm that this treatment-free period has not been forfeited without benefit. The implication that selection for homologous recombination deficiency (HRD) may not be required in patients with germline wild-type BRCA1 or BRCA2 is also problematic. In the HRD-positive subgroup, progression-free survival was increased by 9.1 months, versus 3.1 months in the HRD-negative exploratory subgroup, yielding a progression-free survival benefit of 5.4 months overall. Although the prespecified end point was met, the findings with respect to progressionfree survival suggest that most of the benefit occurred in the 55% of patients who were HRDpositive and who had data that could be evaluated. Previous studies have shown that benefits in biomarker-positive patients can be sufficient to yield an apparent benefit in larger unselected populations.4,5