Comparative effectiveness and safety of treatment regimens for recurrent advanced ovarian cancer: a systematic review and network meta-analysis
The choice of treatment options for recurrent advanced ovarian cancer is very important. However, the most effective treatment options remain unclear. We searched the PubMed, Web of Science, and Cochrane Library databases and the proceedings of the last 5 years of several meetings on ovarian cancer according to the inclusion and exclusion criteria. Randomized controlled trials (RCTs) of recurrent treatment for advanced ovarian cancer with progression-free survival (PFS) were reticulated network meta-analyzed. RCTs were also analyzed for Grades 3 or higher drug-associated adverse events. We included 24 RCTs involving 6,250 patients with advanced recurrent ovarian cancer and a total of 10 treatment regimens. Our network meta-analysis revealed that the PARP plus anti-angiogenic regimen (Surface Under the Cumulative Ranking Curve, SUCRA 95.26%) outperformed eight other regimens and demonstrated a significant improvement in patient survival. The double immunotherapy plus chemotherapy regimen (SUCRA: 87.24%) showed strong efficacy. Additionally, the anti-angiogenic plus chemotherapy regimens (SUCRA: 60.14%), single anti-angiogenic regimens (SUCRA: 52.3%), and poly ADP-ribose polymerase regimens (SUCRA: 61.82%) demonstrated similar efficacy. Interestingly, immunotherapy plus chemotherapy regimens (SUCRA: 31.61%) showed a significant improvement compared to chemotherapy regimens, and double immunotherapy regimens (SUCRA: 36.49%) also demonstrated strong efficacy. However, single immunotherapy regimens (SUCRA: 8.53%) demonstrated limited efficacy. Finally, we found that the incidence of grade 3 or higher adverse reactions was low and manageable for all treatment options. This meta-analysis showed that the PARP plus anti-angiogenic regimen is superior to the other nine regimens in treating patients with advanced recurrent ovarian cancer and can significantly improve their survival. Our results show that the anti-angiogenic plus CT, single-agent anti-angiogenic, and single-agent PARP regimens have similar efficacies; therefore, clinical treatment plans can be adjusted based on the differences in side effects among the three regimens. The double immunotherapy regimen demonstrated superior efficacy compared to the single immunotherapy regimen, particularly in terms of patient survival. These results may offer new therapeutic options for patients with advanced recurrent ovarian cancer, particularly through the use of immunotherapy. PROSPERO (ID CRD420251007476) https://www.crd.york.ac.uk/PROSPERO/view/CRD420251007476 .