Platinum versus platinum-combination chemotherapy in platinum-sensitive recurrent ovarian cancer: A meta-analysis using individual patient data

F. A. Raja, N. Counsell, N. Colombo, J. Pfisterer, A. du Bois, M. K. Parmar, I. B. Vergote, A. Gonzalez-Martin, D. S. Alberts, M. Plante, V. Torri, J. A. Ledermann

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44 Scopus citations

Abstract

The majority of women with ovarian cancer develop recurrent disease. For patients with a platinum-free interval of >6 months, platinum-based chemotherapy is a treatment of choice. The benefit of platinum-based combination chemotherapy in randomized trials varies, and a meta-analysis was carried out to gain more secure information on the size of the benefit of this treatment. Materials and methods: We initiated a systematic review and meta-analysis following a pre-specified protocol to determine whether combination chemotherapy is superior to single-agent platinum chemotherapy in women with relapsed platinum-sensitive ovarian cancer. Results: A total of five potentially eligible randomized trials were identified that had used combination-platinum chemotherapy versus single-agent platinum chemotherapy in women with relapsed platinum-sensitive ovarian cancer. For one trial (190 patients), adequate contact with the investigators could not be established. Therefore, four trials that randomly assigned 1300 patients were included, with a median follow-up of 36.1 months. Overall survival (OS) analyses were based on 865 deaths and demonstrated evidence for the benefit of combination-platinum chemotherapy (HR = 0.80; 95% CI, 0.64-1.00; P = 0.05). Progression-free survival (PFS) analyses were based on 1167 events and demonstrated strong evidence for the benefit of combination-platinum chemotherapy (HR = 0.68; 95% CI, 0.57-0.81; P < 0.001). There was no evidence of a difference in the relative effect of combination-platinum chemotherapy on either OS or PFS in patient subgroups defined by previous paclitaxel (Taxol) treatment (OS, P = 0.49; PFS, P = 0.66), duration of treatment-free interval (OS, P = 0.86; PFS, P = 0.48) or the number of previous lines of chemotherapy (OS, P = 0.21; PFS, P = 0.27). Conclusions: In this individual patient data (IPD) meta-analysis, we have demonstrated that combination-platinum chemotherapy improves OS and PFS across all subgroups. This provides the strongest evidence to date of the benefit of combination-platinum over single-agent platinum.

Original languageEnglish (US)
Article numbermdt406
Pages (from-to)3028-3034
Number of pages7
JournalAnnals of Oncology
Volume24
Issue number12
DOIs
StatePublished - Dec 1 2013

Keywords

  • IPD meta-analysis
  • Recurrent ovarian cancer

ASJC Scopus subject areas

  • Hematology
  • Oncology

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    Raja, F. A., Counsell, N., Colombo, N., Pfisterer, J., du Bois, A., Parmar, M. K., Vergote, I. B., Gonzalez-Martin, A., Alberts, D. S., Plante, M., Torri, V., & Ledermann, J. A. (2013). Platinum versus platinum-combination chemotherapy in platinum-sensitive recurrent ovarian cancer: A meta-analysis using individual patient data. Annals of Oncology, 24(12), 3028-3034. [mdt406]. https://doi.org/10.1093/annonc/mdt406