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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

Risk of discontinuing treatment due to adverse events (CTCAE≥3) in the targeted maintenance therapy group versus the control group.M-H = Mantel-Haenszel method; CI = confidence interval. CTCAE: Common Terminology Criteria for Adverse Events.
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pone.0139026.g005: Risk of discontinuing treatment due to adverse events (CTCAE≥3) in the targeted maintenance therapy group versus the control group.M-H = Mantel-Haenszel method; CI = confidence interval. CTCAE: Common Terminology Criteria for Adverse Events.

Mentions: Generally, level 3/4 grade adverse events (according to CTCAE: Common Terminology Criteria for Adverse Events) are considered to affect quality of life [18, 22]. Therefore, we assessed the quality of life in the patients that experienced level 3/4 adverse events. As shown in Table 3, adverse events that were reported in more than 5 of the trials were defined as abdominal pain, fatigue, diarrhea, nausea, constipation, vomiting, hypertension, and joint pain. Pool OR values suggested that maintenance therapy using targeted agents significantly increased the incidence of fatigue (OR = 2.72, 95%CI: 1.44 to 13, p = 0.002), diarrhea (OR = 4.77, 95%CI: 2.68 to 8.48, p < 0.001), nausea (OR = 3.63, 95%CI: 1.09 to 12.03, p = 0.04), vomiting (OR = 2.86, 95%CI: 1.07 to 7.68, p = 0.04), hypertension (OR = 4.44, 95%CI: 3.16 to 6.22, p < 0.001) but did not markedly increase the incidence of abdominal pain (OR = 1.10, 95%CI: 0.69 to 1.76, p = 0.42), constipation (OR = 0.69, 95%CI: 0.22 to 2.15, p = 0.53) or joint pain (OR = 0.97, 95%CI: 0.30 to 3.18, p = 0.96). Overall, the risk of withdrawal of treatment as a result of adverse events was significantly increased in the targeted maintenance therapy groups when compared to the placebo groups (OR = 4.08, 95%CI: 1.92 to 8.68, p < 0.001 and I2 = 86%; see Fig 5). The obvious heterogeneity might be related to the prevention of risks, benefits, and financial costs. The conclusion assessing withdrawal of treatment should be used cautiously.


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)

Risk of discontinuing treatment due to adverse events (CTCAE≥3) in the targeted maintenance therapy group versus the control group.M-H = Mantel-Haenszel method; CI = confidence interval. CTCAE: Common Terminology Criteria for Adverse Events.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0139026.g005: Risk of discontinuing treatment due to adverse events (CTCAE≥3) in the targeted maintenance therapy group versus the control group.M-H = Mantel-Haenszel method; CI = confidence interval. CTCAE: Common Terminology Criteria for Adverse Events.
Mentions: Generally, level 3/4 grade adverse events (according to CTCAE: Common Terminology Criteria for Adverse Events) are considered to affect quality of life [18, 22]. Therefore, we assessed the quality of life in the patients that experienced level 3/4 adverse events. As shown in Table 3, adverse events that were reported in more than 5 of the trials were defined as abdominal pain, fatigue, diarrhea, nausea, constipation, vomiting, hypertension, and joint pain. Pool OR values suggested that maintenance therapy using targeted agents significantly increased the incidence of fatigue (OR = 2.72, 95%CI: 1.44 to 13, p = 0.002), diarrhea (OR = 4.77, 95%CI: 2.68 to 8.48, p < 0.001), nausea (OR = 3.63, 95%CI: 1.09 to 12.03, p = 0.04), vomiting (OR = 2.86, 95%CI: 1.07 to 7.68, p = 0.04), hypertension (OR = 4.44, 95%CI: 3.16 to 6.22, p < 0.001) but did not markedly increase the incidence of abdominal pain (OR = 1.10, 95%CI: 0.69 to 1.76, p = 0.42), constipation (OR = 0.69, 95%CI: 0.22 to 2.15, p = 0.53) or joint pain (OR = 0.97, 95%CI: 0.30 to 3.18, p = 0.96). Overall, the risk of withdrawal of treatment as a result of adverse events was significantly increased in the targeted maintenance therapy groups when compared to the placebo groups (OR = 4.08, 95%CI: 1.92 to 8.68, p < 0.001 and I2 = 86%; see Fig 5). The obvious heterogeneity might be related to the prevention of risks, benefits, and financial costs. The conclusion assessing withdrawal of treatment should be used cautiously.

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