Abstract
This study compared the short-term efficacies of different chemotherapy regimens in the treatment of advanced ovarian cancer (AOC) through pair-wise and network meta-analyses (NMA). Randomized controlled trials (RCTs) identified in a comprehensive online literature search met our inclusion criteria. Direct and indirect evidence was combined to compare odds ratios (OR) and surfaces under the cumulative ranking curves (SUCRA) across the different treatment regimens. Twelve eligible RCTs were finally included, involving eight regimens (Paclitaxel + Carboplatin [PC], Gemcitabine + Carboplatin [GC], Carboplatin, Pegylated Liposomal Doxorubicin + Carboplatin [PLD + Carboplatin], Paclitaxel, Paclitaxel + Carboplatin + Topotecan [PC + Topotecan], Paclitaxel + Carboplatin + Epirubicin [PC + Epirubicin] and Docetaxel + Carboplatin [DC]). The NMA results revealed that in terms of overall response rate (ORR) and disease control rate (DCR), PC (ORR: OR=2.59, 95%CI=1.20–6.22; DCR: OR=2.58, 95%CI=1.05–6.82) and GC (ORR: OR=2.08, 95%CI=1.08–4.37; DCR: OR=2.43, 95%CI=1.07–5.80) were more effective against AOC than Carboplatin alone. Similarly, PC (OR=0.21, 95%CI=0.05–0.69), GC (OR=0.31, 95%CI=0.09–0.90) and PLD + Carboplatin (OR=0.22, 95%CI=0.04–0.92) slowed disease progression better than Carboplatin alone. We also found that PC was more efficacious against AOC than Carboplatin or Paclitaxel single-agent chemotherapy. Combination chemotherapy is thus recommended for AOC, and should guide subsequent drug development and treatment strategies.
Highlights
Ovarian cancer (OC) is the second most common gynecological cancer in women, after endometrial cancer [1]
We found that Paclitaxel + Carboplatin (PC) was more efficacious against advanced ovarian cancer (AOC) than Carboplatin or Paclitaxel single-agent chemotherapy
In terms of progression-free survival, previous studies showed that PC was more efficacious than Gemcitabine + Carboplatin (GC) [23], while no difference was detected when PC was compared to Pegylated Liposomal Doxorubicin (PLD) + Carboplatin [20, 34], PC + Topotecan [35], PC + Epirubicin [36, 37] or Docetaxel + Carboplatin (DC) [26]
Summary
Ovarian cancer (OC) is the second most common gynecological cancer in women, after endometrial cancer [1]. Some 238,719 OC cases were reported in 2012, with 151,917 deaths worldwide [2]. The etiology of OC is not yet fully understood, certain factors, including age, late childbearing, early onset at menarche, late menopause, and breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) mutations, are implicated in OC formation and development [3, 4]. Lack of early diagnosis may be a key factor in disease progression. According to a previous study, only 25% of patients were diagnosed with earlystage OC while 58% and 17% of cases were diagnosed with stage III and IV disease, with 10-year survival rates of 21% and
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