Background: Numerous randomized trials have been conducted comparing different chemotherapy regimens in women with ovarian cancer. The exact magnitude of incremental benefits across all these diverse regimens is unclear due to the large number of regimens and changes in comparators over time.

Objectives: To examine the magnitude of incremental survival benefits with diverse chemotherapy regimens in ovarian cancer in the last four decades.

Methods: We employed multiple treatment meta-analysis methodology to combine information from direct and indirect comparisons of all different chemotherapy regimens used in randomized trials of women with ovarian cancer. Chemotherapy regimens were categorized in 14 categories.

Results: We found 198 different trials (n=38,440 randomized women) involving 120 different chemotherapy regimens. Of those, 82 trials compared different categories of chemotherapy and 60 of them (representing nine categories) had also collected usable survival information on 15,609 women. Combining direct and indirect evidence, it was 92% probable that the best regimen for survival prolongation was a platinum+taxane combination including intraperitoneal administration; this regimen resulted in 55% relative risk reduction (RRR) (95% CI, 39-67%) for mortality as compared with a regimen using neither platinum nor taxane. Platinum-based combinations with or without intraperitoneal administration achieved 30% (95% CI, 20-38%) and 40% (95% CI, 21-54%) RRR, respectively, and combinations involving both platinum or taxanes without any intraperitoneal administration achieved 42% (95% CI, 31-51%) RRR. Results were similar when limited to first line treatments only. Data on second line treatment were sparse but consistent with the superiority of platinum+taxane combinations.

Conclusions: Multiple treatment meta-analysis demonstrates the magnitude of incremental benefits achieved with evolving
chemotherapy regimens in ovarian cancer.