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Maintenance Therapy in Ovarian Cancer with Targeted Agents Improves PFS and OS: A Systematic Review and Meta-Analysis.

Qian X, Qin J, Pan S, Li X, Pan Y, Ma S - PLoS ONE (2015)

Bottom Line: A total of 13 RCTs, which were published between 2006 and 2014, were found to be in accordance with our inclusion criteria.When taking safety into consideration, the use of targeted agents was significantly correlated with increased risks of fatigue, diarrhea, nausea, vomiting, and hypertension.However, no significant differences were found in incidence rates of abdominal pain, constipation or joint pain.

View Article: PubMed Central - PubMed

Affiliation: Department of Chemotherapy, Hangzhou First People's Hospital, Hangzhou Cancer Hospital, Hangzhou, Zhejiang, P.R. China.

ABSTRACT

Background: Maintenance therapy with targeted agents for prolonging remission for ovarian cancer patients remains controversial. As a result, a meta-analysis was conducted to assess the effectiveness and safety of using maintenance therapy with targeted agents for the treatment of ovarian cancer.

Methods: From inception to January 2015, we searched for randomized, controlled trials (RCTs) using the following databases: PubMed, ScienceDirect, the Cochrane Library, Clinicaltrials.gov and EBSCO. Eligible trials included RCTs that evaluated standard chemotherapy which was either followed or not followed by targeted maintenance in patients with ovarian cancer who had been previously receiving adjunctive treatments, such as cytoreductive surgery and standard chemotherapy. The outcome measures included progression-free survival (PFS), overall survival (OS) and incidence of adverse events.

Results: A total of 13 RCTs, which were published between 2006 and 2014, were found to be in accordance with our inclusion criteria. The primary meta-analysis indicated that both PFS and OS were statistically and significantly improved in the targeted maintenance therapy group as compared to the control group (PFS: HR = 0.84, 95%CI: 0.75 to 0.95, p = 0.001; OS: HR = 0.91, 95%CI: 0.84 to 0.98, p = 0.02). When taking safety into consideration, the use of targeted agents was significantly correlated with increased risks of fatigue, diarrhea, nausea, vomiting, and hypertension. However, no significant differences were found in incidence rates of abdominal pain, constipation or joint pain.

Conclusions: Our results indicate that targeted maintenance therapy clearly improves the survival of ovarian cancer patients but may also increase the incidence of adverse events. Additional randomized, double-blind, placebo-controlled, multicenter investigations will be required on a larger cohort of patients to verify our findings.

No MeSH data available.


Related in: MedlinePlus

Hazard ratios of progression-free survival.SE = standard error; IV = inverse variance method; CI = confidence interval.
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pone.0139026.g003: Hazard ratios of progression-free survival.SE = standard error; IV = inverse variance method; CI = confidence interval.

Mentions: Almost all of the included trials (12/13) [8, 9, 12–15, 18, 20–22, 24, 25] considered PFS as the primary end point and OS or trial termination as the secondary end point. All 12 trials provided HR values regarding PFS. Here, we chose a random-effects model because of the differences that were observed between the above discussed trial groups (p < 0.0001 and I2 = 94%). By sensitivity analyses, we excluded the trial by Ledermann for high heterogeneity [8]. Then the heterogeneity among the left 11 trials as measured by PFS changed to an acceptable level (I2 = 66%). Targeted maintenance therapy was found to significantly improve PFS when compared to placebo groups (HR = 0.84, 95%CI: 0.75 to 0.95, p = 0.001, see Fig 3).


Maintenance Therapy in Ovarian Cancer with Targeted Agents Improves PFS and OS: A Systematic Review and Meta-Analysis.

Qian X, Qin J, Pan S, Li X, Pan Y, Ma S - PLoS ONE (2015)

Hazard ratios of progression-free survival.SE = standard error; IV = inverse variance method; CI = confidence interval.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4581706&req=5

pone.0139026.g003: Hazard ratios of progression-free survival.SE = standard error; IV = inverse variance method; CI = confidence interval.
Mentions: Almost all of the included trials (12/13) [8, 9, 12–15, 18, 20–22, 24, 25] considered PFS as the primary end point and OS or trial termination as the secondary end point. All 12 trials provided HR values regarding PFS. Here, we chose a random-effects model because of the differences that were observed between the above discussed trial groups (p < 0.0001 and I2 = 94%). By sensitivity analyses, we excluded the trial by Ledermann for high heterogeneity [8]. Then the heterogeneity among the left 11 trials as measured by PFS changed to an acceptable level (I2 = 66%). Targeted maintenance therapy was found to significantly improve PFS when compared to placebo groups (HR = 0.84, 95%CI: 0.75 to 0.95, p = 0.001, see Fig 3).

Bottom Line: A total of 13 RCTs, which were published between 2006 and 2014, were found to be in accordance with our inclusion criteria.When taking safety into consideration, the use of targeted agents was significantly correlated with increased risks of fatigue, diarrhea, nausea, vomiting, and hypertension.However, no significant differences were found in incidence rates of abdominal pain, constipation or joint pain.

View Article: PubMed Central - PubMed

Affiliation: Department of Chemotherapy, Hangzhou First People's Hospital, Hangzhou Cancer Hospital, Hangzhou, Zhejiang, P.R. China.

ABSTRACT

Background: Maintenance therapy with targeted agents for prolonging remission for ovarian cancer patients remains controversial. As a result, a meta-analysis was conducted to assess the effectiveness and safety of using maintenance therapy with targeted agents for the treatment of ovarian cancer.

Methods: From inception to January 2015, we searched for randomized, controlled trials (RCTs) using the following databases: PubMed, ScienceDirect, the Cochrane Library, Clinicaltrials.gov and EBSCO. Eligible trials included RCTs that evaluated standard chemotherapy which was either followed or not followed by targeted maintenance in patients with ovarian cancer who had been previously receiving adjunctive treatments, such as cytoreductive surgery and standard chemotherapy. The outcome measures included progression-free survival (PFS), overall survival (OS) and incidence of adverse events.

Results: A total of 13 RCTs, which were published between 2006 and 2014, were found to be in accordance with our inclusion criteria. The primary meta-analysis indicated that both PFS and OS were statistically and significantly improved in the targeted maintenance therapy group as compared to the control group (PFS: HR = 0.84, 95%CI: 0.75 to 0.95, p = 0.001; OS: HR = 0.91, 95%CI: 0.84 to 0.98, p = 0.02). When taking safety into consideration, the use of targeted agents was significantly correlated with increased risks of fatigue, diarrhea, nausea, vomiting, and hypertension. However, no significant differences were found in incidence rates of abdominal pain, constipation or joint pain.

Conclusions: Our results indicate that targeted maintenance therapy clearly improves the survival of ovarian cancer patients but may also increase the incidence of adverse events. Additional randomized, double-blind, placebo-controlled, multicenter investigations will be required on a larger cohort of patients to verify our findings.

No MeSH data available.


Related in: MedlinePlus