Continued chemotherapy after complete response to primary therapy among women with advanced ovarian cancer: a meta-analysis.
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.
Hess
Lisa M
LM
Department of Public Health, Indiana University School of Medicine, Indianapolis, IN, USA. lmhess@iupui.edu
Rong
Nan
N
Monahan
Patrick O
PO
Gupta
Paridha
P
Thomaskutty
Champ
C
Matei
Daniela
D
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
D000970:Antineoplastic Agents