Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Viale Regina Elena 326, Rome, Italy.
Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Viale Regina Elena 326, Rome, Italy.
Crit Rev Oncol Hematol. 2018 May;125:30-34. doi: 10.1016/j.critrevonc.2018.02.016. Epub 2018 Mar 7.
The use of dose-dense weekly chemotherapy in the management of advanced ovarian cancer (OC) remains controversial. The aim of this meta-analysis was to evaluate the efficacy of dose-dense regimen to improve clinical outcomes in OC patients with the inclusion of new trials.
For this updated meta-analysis, PubMed Medline and Scopus databases and meeting proceedings were searched for eligible studies with the limitation of randomized controlled trials, comparing dose-dense chemotherapy versus standard treatment. Trials were grouped in two types of dose-dense chemotherapy: weekly dose-dense (both paclitaxel and carboplatin weekly administration) and semi-weekly dose-dense (weekly paclitaxel and three weekly carboplatin administration). Data were extracted independently and were analyzed using RevMan statistical software version 5.3 (http://www.cochrane.org). Primary end-point was progression-free survival (PFS).
Four randomized controlled trials comprising 3698 patients were identified as eligible. Dose-dense chemotherapy had not a significant benefit on PFS (HR 0.92, 95% CI 0.81-1.04, p = 0.20). When the analysis was restricted to both weekly and semi-weekly dose-dense data, a no significant interaction between dose-dense and standard regimen was confirmed (HR 1.01, 95% CI 0.93-1.10 and HR 0.82, 95% CI 0.63-1.08, respectively).
In the absence of PFS superiority of dose-dense schedule, three weekly schedule should remain the standard of care for advanced OC.
密集剂量每周化疗在晚期卵巢癌（OC）的治疗中仍然存在争议。本荟萃分析的目的是评估密集剂量方案在包含新试验的 OC 患者中改善临床结局的疗效。
为了进行这项更新的荟萃分析，我们搜索了 PubMed Medline 和 Scopus 数据库以及会议记录，以寻找符合条件的研究，这些研究仅限于随机对照试验，比较密集剂量化疗与标准治疗。试验分为两种类型的密集剂量化疗：每周密集剂量（紫杉醇和卡铂每周给药）和半周密集剂量（每周紫杉醇和三周卡铂给药）。数据独立提取，并使用 RevMan 统计软件版本 5.3 进行分析（http://www.cochrane.org）。主要终点是无进展生存期（PFS）。
确定了四项随机对照试验，共纳入 3698 名患者。密集剂量化疗对 PFS 没有显著获益（HR 0.92，95% CI 0.81-1.04，p=0.20）。当分析仅限于每周和半周密集剂量数据时，确认了密集剂量和标准方案之间没有显著的相互作用（HR 1.01，95% CI 0.93-1.10 和 HR 0.82，95% CI 0.63-1.08）。
在密集剂量方案没有 PFS 优势的情况下，三周方案仍应成为晚期 OC 的标准治疗。
