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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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
Article numbermdt406
Pages (from-to)3028-3034
Number of pages7
JournalAnnals of Oncology
Volume24
Issue number12
DOIs
Publication statusPublished - Dec 2013

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Combination Drug Therapy
Platinum
Ovarian Neoplasms
Meta-Analysis
Disease-Free Survival
Survival
Drug Therapy
Survival Analysis
Paclitaxel
Therapeutics
Research Personnel

Keywords

  • IPD meta-analysis
  • Recurrent ovarian cancer

ASJC Scopus subject areas

  • Oncology
  • Hematology

Cite this

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

In: Annals of Oncology, Vol. 24, No. 12, mdt406, 12.2013, p. 3028-3034.

Research output: Contribution to journalArticle

Raja, FA, Counsell, N, Colombo, N, Pfisterer, J, du Bois, A, Parmar, MK, Vergote, IB, Gonzalez-Martin, A, Alberts, DS, Plante, M, Torri, V & Ledermann, JA 2013, 'Platinum versus platinum-combination chemotherapy in platinum-sensitive recurrent ovarian cancer: A meta-analysis using individual patient data', Annals of Oncology, vol. 24, no. 12, mdt406, pp. 3028-3034. https://doi.org/10.1093/annonc/mdt406
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. / Platinum versus platinum-combination chemotherapy in platinum-sensitive recurrent ovarian cancer : A meta-analysis using individual patient data. In: Annals of Oncology. 2013 ; Vol. 24, No. 12. pp. 3028-3034.
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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.",
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AU - Pfisterer, J.

AU - du Bois, A.

AU - Parmar, M. K.

AU - Vergote, I. B.

AU - Gonzalez-Martin, A.

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AU - Plante, M.

AU - Torri, V.

AU - Ledermann, J. A.

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