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Review
. 2017 Mar 30;8(35):59867-59877.
doi: 10.18632/oncotarget.16729. eCollection 2017 Aug 29.

Efficacy and safety of traditional chemotherapies for patients with ovarian neoplasm: a network meta-analysis

Lili Yang  1 , Gongliang Guo  2 , Liqun Sun  3 , Chenhao Li  4 , Haipeng Zhang  5
Affiliations
Review

Efficacy and safety of traditional chemotherapies for patients with ovarian neoplasm: a network meta-analysis

Lili Yang et al. Oncotarget. .

Abstract

Background: Ovarian neoplasm is a kind of high risky cancer among female. This paper assessed the efficacy and safety of twelve therapies and figured out the superior chemotherapeutic drug for ovarian cancer through network meta-analysis (NMA).

Method: Eligible randomized controlled trials (RCTs) were retrieved from electronic databases. Primary outcomes concerning efficacy, overall survival (OS) and progression-free survival (PFS), were presented as hazard ratio (HR) and the associated 95% credible interval(CrI), while outcomes concerning safety were assessed by odds ratio (OR) and the corresponding 95% CrI. Surface under the cumulative ranking curve (SUCRA) was calculated under each survival and safety outcome in order to show the rankings of tested therapies.

Result: Electronic databases such as PubMed and Embase were searched to finally obtain 19 eligible studies of 16290 patients. In accordance of primary outcomes, when it came to 3-y PFS, paclitaxel/epirubicin/carboplatin (Pa/E/Ca) and pegylated liposomal doxorubicin/ paclitaxel/ carboplatin (PLD/Pa/Ca) were preferred compared to carboplatin (Ca) (HR= 0.80, 95% CrI= 0.67-0.96; HR= 0.83, 95% CrI= 0.69-0.99). According to 5y-PFS, Pa/E/Ca was notably better than Ca (HR= 0.80, 95% CrI= 0.65-0.99). As to adverse effects, Ca was superior to Pa/E/Ca in neuropathy (HR=0.05, 95% CrI=0.02-0.19). Pa/E/Ca showed high rankings in 3y-PFS (SUCRA=0.749), 5y-OS (SUCRA=0.738) and 5y-PFS (SUCRA=0.798) while (PLD/Pa/Ca) in 3y-OS (SUCRA=0.737), 5y-OS (SUCRA=0.687) and 5y-PFS (SUCRA=0.712). Besides, Pa/E/Ca ranked the third with a SUCRA of 0.661 in neutropenia.

Conclusion: PLD/Pa/Ca, PLD/Ca and Pa/E/Ca are highly recommended as potential therapeutically choices for patients with ovarian cancer. But considering the lack of safety data for PLD/Pa/Ca, this intervention should be taken with caution.

Keywords: carboplatin; network meta-analysis; ovarian neoplasm; paclitaxel; pegylated liposomal doxorubicin.

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Conflict of interest statement

CONFLICTS OF INTEREST The authors declare no financial interests in the findings described in the manuscript.

Figures

Figure 1
Figure 1. Flow diagram of included and excluded studies
Figure 2
Figure 2. Network diagram of all included studies
Each node represents a treatment type; the diameters of circles represents the number of people involved and the widths of lines between two nodes represents the number of study involved in the head-to-head comparison. Abbreviation: Ir: Irinotecan; Ci: Cisplatin; Pa: Paclitaxel; Ca: Carboplatin; PLD: Pegylated liposomal doxorubicin; G: Gemcitabine; T: Topotecan; D: Doxorubicin; Cy: Cyclophosphamide; Ia: Interferon-alpha; E: Epirubicin.
Figure 3
Figure 3. Forest plot of the efficacy outcomes
Results are expressed as hazard ratio (HR) with 95% credible interval (CrI). Abbreviation: OS: Overall survival; PFS: Progression-free survival; Ir: Irinotecan; Ci: Cisplatin; Pa: Paclitaxel; Ca: Carboplatin; PLD: Pegylated liposomal doxorubicin; G: Gemcitabine; T: Topotecan; D: Doxorubicin; Cy: Cyclophosphamide; Ia: Interferon-alpha; E: Epirubicin.
Figure 4
Figure 4. Cluster analysis of long-term efficacy outcomes
Treatments in orange suggest a high ranking in both horizontal and vertical ordinate outcomes and treatments in blue suggest a low ranking. Abbreviation: OS: Overall survival; PFS: Progression-free survival; Ir: Irinotecan; Ci: Cisplatin; Pa: Paclitaxel; Ca: Carboplatin; PLD: Pegylated liposomal doxorubicin; G: Gemcitabine; T: Topotecan; D: Doxorubicin; Cy: Cyclophosphamide; Ia: Interferon-alpha; E: Epirubicin.
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