Abstract
Objective This meta-analysis was conducted to compare the therapeutic efficacy and clinical safety of the combination therapy of apatinib plus chemotherapy with that of chemotherapy alone in patients with refractory or recurrent ovarian carcinoma (OC). Methods Relevant randomized controlled trials (RCT) or case-control studies (CCS) were identified by searching Chinese and English databases up to October 31, 2020. The risk of methodological bias tool and Newcastle–Ottawa scale (NOS) were used to assess trial quality. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated to evaluate the therapeutic effects and adverse drug reactions. Subgroup analyses of study type, study sample size, dosage of apatinib, and chemotherapy regimen between treatment group and control group were performed. Publication bias was assessed by funnel plot symmetry, Begg–Mazumdar test, and Egger test. The robustness of our results was presented by removing the trial one by one. Results Fifteen eligible studies covering 1,020 patients were included in this review and meta-analysis. Among these studies, 8 were RCTs, and 7 were CCSs. Compared with chemotherapy alone, apatinib plus chemotherapy significantly increased objective response rate (OR = 3.55; 95% CI 2.31 to 5.47), disease control rate (OR = 3.04; 95% CI 2.12 to 4.36), and overall survival (OR = 5.03; 95% CI 3.16 to 6.90). Conclusions The combination treatment of apatinib plus chemotherapy provides better clinical benefits for OC patients when compared to chemotherapy alone and should be recommended for suitable patients with OC after the failure of standard regimens. However, further investigation into future large-scale prospective randomized research is still needed.
Highlights
Ovarian carcinoma (OC) is one of the common malignant carcinomas in women worldwide
For OC, increasing clinical studies have confirmed that apatinib alone or apatinib combined with chemotherapy can prolong the progression-free survival (PFS) of recurrent OC that is resistant to platinum-based chemotherapeutics [8,9,10]
Inclusion Criteria. e systematic review and metaanalysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. e inclusion criteria for the studies were as follows: (1) the type of included study was a randomized controlled trial (RCT) or case-control study (CCS), and there was no limit to follow-up procedures or type of setting; (2) the participants were confirmed to have OC pathologically or computed tomography, and there was no restriction on gender, race, or nationality for them; and (3) the intervention was apatinib combined with chemotherapy versus chemotherapy alone, and no patients had received chemotherapy, radiotherapy, targeted therapy, or other therapies within one month before treatment
Summary
Ovarian carcinoma (OC) is one of the common malignant carcinomas in women worldwide. In 2018 alone, over 295,000 women developed OC, of whom over 184,000 died globally [1]. Surgery and chemotherapy can be curative for patients with early-stage OC, most women with advanced OC suffer repeated recurrences of the disease with a progressively shorter disease-free interval [2] and platinum resistance [3]. For OC, increasing clinical studies have confirmed that apatinib alone or apatinib combined with chemotherapy can prolong the progression-free survival (PFS) of recurrent OC that is resistant to platinum-based chemotherapeutics [8,9,10]. Due to the small sample size of relevant clinical studies and a lack of multicenter randomized controlled clinical trials, there is still a lack of sufficient evidence to confirm the clinical efficacy and safety of apatinib combined with chemotherapy in the treatment of OC. Due to the small sample size of relevant clinical studies and a lack of multicenter randomized controlled clinical trials, there is still a lack of sufficient evidence to confirm the clinical efficacy and safety of apatinib combined with chemotherapy in the treatment of OC. erefore, we have performed a systematic review and meta-analysis to assess the efficacy and safety of apatinib plus chemotherapy
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