title: Continued chemotherapy after complete response to primary therapy among women with advanced ovarian cancer: a meta-analysis.
abstract: BACKGROUND
  Ovarian cancer (OC) is associated with a >75% risk of recurrence after completion of primary therapy. Several clinical trials have explored the role of continued therapy after complete response to primary adjuvant therapy to reduce the risk of recurrence; however, these trials have largely been underpowered, leading to inconclusive results.
  
  
  METHODS
  A systematic search strategy was initiated to identify all clinical trials involving consolidation or maintenance therapy regimens for OC in first complete remission. A meta-analysis was conducted to evaluate toxicity and progression-free (PFS) and overall survival (OS).
  
  
  RESULTS
  There were 37 publications meeting all eligibility criteria, representing 20 consolidation and 9 maintenance therapy trials. Consolidation and maintenance therapies were associated with improved PFS (hazard ratio [HR], 0.79 [P = .003] and HR, 0.82 [P = .02], respectively) and OS (HR, 0.68 [P = .0008] and HR, 0.68 [P = .007], respectively). This relationship remained statistically significant when the analysis was limited to randomized trials and across other sensitivity analyses.
  
  
  CONCLUSIONS
  Although individual studies have not yet convincingly shown a survival advantage with maintenance chemotherapy in OC, this meta-analysis demonstrates that continued chemotherapy after completion of primary therapy for OC improves PFS and OS. Benefits are greatest in patients with advanced stage OC who reach complete clinical or pathologic response after primary therapy.
authors.affiliation: Department of Public Health, Indiana University School of Medicine, Indianapolis, IN, USA. lmhess@iupui.edu
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Hess
authors.forename: Nan
authors.initials: N
authors.lastname: Rong
authors.forename: Patrick O
authors.initials: PO
authors.lastname: Monahan
authors.forename: Paridha
authors.initials: P
authors.lastname: Gupta
authors.forename: Champ
authors.initials: C
authors.lastname: Thomaskutty
authors.forename: Daniela
authors.initials: D
authors.lastname: Matei
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D012074:Remission Induction; D012680:Sensitivity and Specificity; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents