Abstract
Background: The efficacy and safety of different adjuvant therapies for post-surgery ovarian carcinoma remains controversial. We performed a random-effects Bayesian network meta-analysis (NMA) to provide comprehensive assessment. Methods: Full text reports of randomized clinical trials in this field were identified from Pubmed, Embase and the Cochrane Library. Randomized clinical trials comparing adjuvant treatment regiments for post-surgery ovarian cancer patients were included. A random-effets Bayesian NMA was employed. Findings: 52 randomized controlled trials (20801 patients) comparing 20 different regimens were included. Compared with the classic carboplatin plus paclitaxel (CT), intraperitoneal plus intravenous (IP/IV) regimen was associated with longer overall survival (OS) with HR 0*83, 95% CI, 0*69-0*9, while carboplatin plus paclitaxel plus bevacizumab (CTBeva) provided longer progression free survival (PFS) with HR 0*85, 95% CI, 0*71-0*99. No significant distinction was found between IP/IV and CTBeva. Triplet regimens were not superior to CT as double regimens on both OS and PFS. CTBeva showed no dramatic divergences on overall toxic effect, haematological and gastrointestinal toxicity compared with CT, while IP/IV was associated with higher risk of gastrointestinal toxicity (pooled RR, 3*76; 95% CI, 1*13-9*23). In addition, the haematological toxicity of triplet regimens was worse than CT (pooled RR, 3*00; 95% CI, 1*48-5*54). Interpretation: Adjuvant therapy for ovarian cancer with IP/IV regimen provided an OS advantage over CT, while CTBeva prolonged PFS. IP/IV and CTBeva shown similar efficacy. No additional toxic effects were validated in the present comparisons except GI toxicity brought by IP/IV regimen. Furthermore, the triplet regimens were not superior. Funding Statement: This work was supported by the National Natural Science Foundation of China [grant numbers 81302455 and 31471297] and the Natural Science Foundation of Zhejiang Province [grant number LY15H160007]. Declaration of Interest: The authors declare that they have no conflict of interests. Ethics Approval Statement: Institutional Review Board approval was not required for this study.
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