Abstract
ObjectivesThe current gold-standard for the first-line treatment in IIIb/IV stages of epithelial ovarian cancer (EOC) is the combination of carboplatin and paclitaxel plus bevacizumab in some countries. In the era of personalized medicine, there is still uncertainty on the impact of several molecularly targeted agents, which have been investigated for the management of this disease. To shed light on the actual role of targeted therapy in EOC, a systematic review and meta-analysis was performed.MethodsClinical trials were selected by searching “Pubmed” database and abstracts from major cancer meetings within the time-frame of January 2004-June 2015. The endpoints were survival outcome and response rate (RR). Hazard ratios (HRs) of survival outcomes, with confidence intervals and odds-ratios (ORs) of RR, were extracted from retrieved studies and used for current analysis. Meta-analysis was carried out by random effect model.Results30 randomized trials for a total of 10,530 patients were selected and included in the final analysis. A benefit in terms of OS (pooled HR 0.915; 95%CI 0.840-0.997; p=0.043), particularly for anti-angiogenetic agents (HR 0.872; 95%CI 0.761-1.000; p=0.049), has been demonstrated for targeted therapy. Moreover, a significant advantage in platinum-resistant subgroup in term of PFS (HR 0.755; 95%CI 0.624-0.912; p=0.004) was found.ConclusionsThis systematic review and meta-analysis provide the first evidence that targeted therapy is potentially able to translate into improved survival of EOC patients, with a major role played by anti-angiogenetic drugs. The role of target therapy is underlined in the platinum-resistant setting that represents the “pain in the neck” in EOC management.
Highlights
Description of epidemiology and clinical managementEpithelial ovarian cancer (EOC) is the leading cause of gynaecologic cancer mortality in developed countries
This systematic review and meta-analysis provide the first evidence that targeted therapy is potentially able to translate into improved survival of epithelial ovarian cancer (EOC) patients, with a major role played by anti-angiogenetic drugs
The role of target therapy is underlined in the platinum-resistant setting that represents the “pain in the neck” in EOC management
Summary
Description of epidemiology and clinical managementEpithelial ovarian cancer (EOC) is the leading cause of gynaecologic cancer mortality in developed countries. 2 clinical trials successfully investigated the role of bevacizumab, an anti-VEGF monoclonal antibody, in the first-line treatment, showing significant advantage in term of progression free survival (PFS) in combination to standard carboplatin and paclitaxel schedule [5, 6]. The selection of second-line treatment takes into account the efficacy of previous therapy, in term of the interval lenght from last platinum administration. On this basis, it is possible to offer platinum re-challenge to patients whose recurrence occurs 12 months after last platinum cycle and a different monotherapy in refractory/resistant platinum patients, whose recurrence occurs within 6 months from last platinum treatment [7,8,9,10]
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