IP CT after upfront cytoreductive surgery has been the standard of care in EOC. Nevertheless, results from the recent GOG252 trial showed no impact of this strategy vesus IV CT in the concurrence of bevacizumab therapy. The aim of this study was to perform a meta-analysis of the survival benefit of IP vs IV CT after cytoreductive surgery including recent evidence.
A literature search in order to identify most relevant RCT comparing IV vs IP CT after cytoreductive surgery in EOC was performed. Non comparative studies or trials with no hazard or risk ratios were excluded. Statistical analyses were done using SPSS STATISTICS V.21. Fixed-effect meta-analysis for combining data was made. Degree of heterogeneity using the I2statistic was calculated. Endpoints meta-analysed were disease-free survival (DFS) and overall survival (OS).
Initially 92 papers were identified. After exclusion criteria only nine RCT including pooled data from 3668 pts (2068 treated with IP CT and 1620 treated with IV CT) were included. In 8 RCTs IPCT was given after upfront surgery and in 1 (OV21/PETROC) after neoadjuvant CT. In all RCTs 6 CT cycles were foreseen in the IP arms. Seven RCTs including 3006 pts had DFS as endpoint. Among these, GOG252 cohorts A and B were analysed separately. IP CT showed a survival benefit over IV CT with HR = 0.86; (95% confidence interval (CI): 0.80 to 0.93). Heterogeneity was moderate (I2=37.3) Eight RCTs including 2289 pts had OS as endpoint. IP CT showed a significant impact on OS with HR = 0.81; 95% CI: 0.73 to 0.90). Heterogeneity was low (I2<0.01). Benefit of IP CT remained unchanged in the sensitivity analysis performed for both DFS and OS by eliminating the latest RCT of the meta-analysis.
IP CT benefits DFS and OS in this meta-analysis of pooled data from 9 RCTs and 3668 pts including latest negative results.
Clinical trial identification
Legal entity responsible for the study
Hospital Clinico Universitario de Valencia. INCLIVA.
Has not received any funding.
All authors have declared no conflicts of interest.