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

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.