NEW YORK (Reuters Health) – Compared to single-agent platinum chemotherapy, platinum-combination chemotherapy improves survival in patients with recurrence of ovarian cancer, a meta-analysis has shown.
The researchers say the results provide “the strongest evidence to date that combination therapy should be considered as the standard of care for those women who are fit to receive combination therapy.”
As they explain in the Annals of Oncology online November 4, platinum-based chemotherapy is the treatment of choice for recurrent ovarian cancer, but the benefit of combining platinum with other agents has varied in clinical trials.
Dr. Fharat A. Raja, at the UCL Cancer Trials Centre in London, and colleagues therefore conducted a meta-analysis of data from randomized trials that compared combination-platinum chemotherapy versus single-agent platinum chemotherapy in women with relapsed platinum-sensitive ovarian cancer.
The team identified five eligible trials, but individual patient data could not be obtained from one of them. The current analysis is therefore based mainly on four trials involving a total of 1300 patients followed for a median of 36 months. The combination agents used in the four trials were paclitaxel, gemcitabine, epirubicin, or pegylated liposomal doxorubicin.
There were 856 deaths recorded in the four trials. The pooled data showed a benefit with platinum-combination chemotherapy compared to single-agent platinum in terms of overall survival, with a mortality hazard ratio of 0.80 (p=0.05).
For progression-free survival, the benefit of platinum-combination chemotherapy was stronger (HR 0.68; p<0.001), the authors report.
They also demonstrated that the relative benefit of platinum-combination chemotherapy was independent of previous paclitaxel treatment, duration of treatment-free interval, and number of previous chemotherapy cycles.
In the conclusion to their report, Dr. Raja and colleagues comment: “Patients are now surviving longer after their disease has recurred than before, largely due to the careful use of chemotherapy for recurrent ovarian cancer. Some patients receive up to six lines of chemotherapy for their relapsed disease. The judicious use of chemotherapy at relapse is therefore of paramount importance.”
