Introduction: Ovarian cancer is a significant contributor to gynecological cancer-related mortality, necessitating innovative treatment strategies. This systematic review and meta-analysis aimed to assess the efficacy and safety of combining PARP inhibitors with anti-angiogenic agents (AAAs) in the treatment of ovarian cancer. Methods: This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and was registered on PROSPERO (CRD42022319461). A systematic search of three electronic databases, including MEDLINE (via PubMed), EMBASE, and Cochrane Library was conducted to identify relevant randomized controlled trials (RCT) that evaluated the efficacy and safety of the combination therapy. Subgroup analyses were based on BRCA mutation status. Meta-analysis was conducted to estimate pooled hazard ratios (HR) and risk ratios (RR) for progression-free survival (PFS) and adverse events, respectively. The combination therapy was compared to PARP inhibitors alone and to chemotherapy. Heterogeneity was assessed using Higgins and Thompson’s I² statistic where applicable. Results: Seven RCTs involving 2397 patients were included. Combination therapy did not show a statistically significant improvement in PFS compared to PARP inhibitor monotherapy in the general population (HR 0.63, CI 0.37–1.06), or in BRCA-mutated (HR 0.70, CI 0.30–1.63) and BRCA wild-type subgroups (HR 0.39, CI 0.14–1.07). When compared to chemotherapy, combination therapy produced no significant PFS benefit in recurrent ovarian cancer (HR 0.83, CI 0.42–1.63) in the total population. Safety analysis revealed that hypertension and diarrhea were significantly more frequent in combination therapy compared with PARP inhibitors alone (RR 6.80, CI 2.87–16.06 and RR 10.04, CI 2.25–44.75) or chemotherapy alone (RR 13.80, CI 3.43–55.57 and RR 6.57, CI 2.84–15.24). Conclusions: The combination of PARP inhibitors and AAAs did not demonstrate a statistically significant benefit in PFS compared to PARP inhibitors or chemotherapy alone in recurrent ovarian cancer. While the combination therapy was generally well tolerated, hypertension and diarrhea occurred significantly. These findings suggest that combination therapy may not provide a clear survival advantage in the recurrent setting. Further high-quality, biomarker-driven clinical trials are needed to refine patient selection, optimize toxicity management, and determine the potential role of combination therapy in ovarian cancer treatment.

Early-stage cervical cancer tumours ≥2 cm present a dilemma for fertility preservation, as guidelines generally discourage fertility-sparing surgery (FSS) due to oncologic risks. Neoadjuvant chemotherapy (NACT) followed by FSS has emerged as an alternative to downstage tumours. This study evaluated recurrence and pregnancy outcomes of NACT + FSS versus upfront FSS. A PROSPERO-registered (CRD42024605906) meta-analysis was conducted using PubMed, EMBASE, and Cochrane (updated Feb 26, 2025). Eligible studies included women with early-stage cervical cancer (FIGO 2018 IB2-IIA1; ≥2 cm) undergoing upfront FSS or NACT + FSS. Pooled proportions with 95% confidence intervals (CIs) were calculated using a random effects model. Nineteen observational studies (n = 1453) were analysed. Indirect comparison indicated significantly higher pooled pregnancy rate for NACT + FSS (31%; 95% CI: 23-41%) compared to upfront FSS (8%; CI: 1-43%; p = 0.002). Pooled recurrence rate was statistically similar: 10% (CI: 5-20%) for upfront FSS and 13% (CI: 9-20%) for NACT + FSS (p = 0.415). Studies generally exhibited a moderate-to-high risk of bias. NACT followed by FSS appears to enhance fertility outcomes without increasing oncologic risk compared to upfront FSS in patients with tumours ≥2 cm. These findings support the personalized extension of fertility-sparing indications, though prospective validation remains necessary.