Chemotherapy regimens for first-line adjuvant treatment
Early stage ovarian cancer (FIGO stage I-IIa)
While meta-analysis of five-year data from three trials, and of ten-year data from two trials, indicated that women who received adjuvant platinum-based chemotherapy had better overall survival (OS) than those who did not, subgroup analysis suggested that women who had comprehensive surgical staging of their disease were unlikely to benefit from adjuvant chemotherapy, whereas those who had sub-optimal staging did.13
One trial included in the Cochrane Review (ICON 1) reported overall survival grouped by level of risk, with low/medium risk, defined as stage 1a, tumour grade 1 and 2, stage 1b or 1c, grade 1; high risk was defined as stage 1a, grade 3, stage 1b or 1c grade 2 or 3, any clear cell tumours. In the low and medium risk group, there was no significant difference in 10-year overall survival between those who received adjuvant chemotherapy and those who received surgery alone. However, among women at high risk, adjuvant chemotherapy improved survival HR 0.48 (95% CI 0.32 to 0.72), p=0.00039.13
Analysis of data from 693 women in three trials, showed no significant difference in deaths from ovarian cancer at five years, between the chemotherapy and observation groups (RR 0.76, 95% CI 0.52 to 1.11). Only one RCT (ACTION) reported 10-year follow-up for this outcome, with no significant difference in deaths from ovarian cancer between the two groups overall. Significantly fewer deaths occurred in the chemotherapy arm of the sub-optimally staged subgroup. However, there was no difference for those in the comprehensively staged subgroup.13
Among comprehensively staged women, analysis showed no significant difference in progression-free survival (PFS) between those who did and did not receive adjuvant chemotherapy. However, in sub-optimally staged women, those receiving adjuvant chemotherapy had significantly better PFS than those who did not.13
ICON 1 reported progression-free survival grouped by level of risk. The 10-year progression-free survival between adjuvant chemotherapy compared with observation was not significantly different among women at low and medium risk. However in women at high risk, adjuvant chemotherapy improved PFS HR 0.52 (95% CI 0.33 to 0.82), p=0.0049.13
None of the trials reported on treatment compliance, response to chemotherapy, adverse events or quality of life.