Ovarian cancer is the 7th most frequent cancer in women. This study seeks to describe epithelial ovarian cancer epidemiology to enable estimation of the number of treatable cases eligible for PD-1/L1 inhibitors, PARP inhibitors, and angiogenesis inhibitors in advanced first-line maintenance setting across 15 European countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Italy, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland, and the United Kingdom). PARP inhibitors are effective treatment options for recurrent, platinum-sensitive, high-grade ovarian cancer, regardless of BRCA1/2 status, but it is a costly treatment and therefore healthcare providers must be able to size this patient population in order to develop budget impact models.

Using peer-reviewed studies and cancer registry data, we estimated the number of incident epithelial ovarian cancer cases, and report these by stage and BRCA1/2 mutation status. Using stage and grade of disease data, we derived the early stage first-line, and advanced stage first-line eligible cases. Using estimates of recurrence-free survival, we modelled the recurrence of early stage first-line cases and early stage non-drug treated cases, assuming that these cases would be eligible for treatment in the second-line. To estimate rates of progression between the first and second lines of metastatic treatment, we relied on estimates of progression-free survival from the literature, as well as estimates obtained from a survey of practicing oncologists. We used database pricing sources to estimate the cost of key drug class treatment.

We estimate that there will be 30,000 incident cases in 2018 of ovarian cancer in the 15 European countries, of which 13% have a mutation in the BRCA1/2 gene. Over the next 10 years, the number of cases will increase with the aging population. Over 4600 will be eligible for early stage treatment, and 23,400 will be eligible for advanced stage first-line maintenance treatment. If PARP inhibitors successfully penetrate the first-line maintenance setting, we estimate that given 51% treatment with these agents, sales could exceed US$ 1 billion by 2028.

Advanced cases account for 83% of the first-line drug-treatable population. By 2028, of the key drug class used to treat ovarian cancer, immune checkpoint inhibitor (PD-1/PD-L1) and PARP inhibitors are expected to make up the majority closely followed by angiogenesis inhibitors.