A total of 198 randomised controlled trials (n=38,440 women) were included. Eighty-two of these (n=15,609) compared different types of regimens and were included in the multiple treatment meta-analysis.
Comparison of chemotherapy regimens.
Six (n=1,154) of the 116 trials that compared only regimens of the same type found statistically significant differences in survival, with median survival ranging from 13.1 to more than 35 months. However, this result did not go beyond what might be expected by chance. In addition, trials following different regimens found only small differences and the probability that these findings were due to chance could not be ruled out.
Comparisons of different types of regimens.
Sixty of the 82 trials that compared different types of regimens contained survival data and were included in the synthesis (16,478 randomly assigned participants; 15,609 in survival analyses). Heterogeneity was found for the comparison of platinum-based combinations versus platinum and taxane-based combinations (I-squared 70%; 4 trials).
Direct comparisons found that platinum monotherapy was statistically significantly more effective than monotherapy with a nonplatinum, nontaxane agent (HR 0.63, 95% CI: 0.48, 0.83), while a platinum-based combination was more effective than monotherapy (HR 0.78, 95% CI: 0.64, 0.94) or combinations involving neither platinum nor taxanes (HR 0.77, 95% CI: 0.69, 0.87). Combinations involving neither platinum nor taxane were better than monotherapy with such agents (HR 1.20, 95% CI: 1.06, 1.36). Platinum and taxane-based combinations were more effective than platinum-based combinations (HR 1.28, 95% CI: 1.07, 1.53), and intraperitoneal administration improved survival with platinum and taxane-based combinations (HR 1.28, 95% CI: 1.07, 1.53).
Multiple treatment meta-analyses.
Sixty trials (15,609 women) reported survival data and were included in the multiple treatment analyses.
Based on multiple-treatment analyses, the following treatment regimens were significantly more effective than monotherapy with non intraperitoneal, nonplatinum, nontaxane regimens: non intraperitoneal platinum-based monotherapy (HR 0.68, 95% CI: 0.59, 0.78), the combination of nonplatinum and nontaxane agents (HR 0.87, 95% CI: 0.78, 0.97), platinum-based combination treatment (HR 0.70, 95% CI: 0.62, 0.80), intraperitoneal platinum-based combination treatment (HR 0.60, 95% CI: 0.46, 0.79), platinum plus taxane-based combination (HR 0.58, 95% CI: 0.49, 0.69), and intraperitoneal platinum plus taxane-based combination treatment (HR 0.45, 95% CI: 0.33, 0.6).
Using Monte Carlo simulations it was 92% likely that combinations of platinum and taxane with intraperitoneal administration were the most effective regimens, and 98% likely that the most effective regimen included intraperitoneal administration.
No important incoherence between comparisons was detected (incoherence was 0.001).
Second-line results appeared to show improved survival with platinum-taxane combinations. However, owing to the small number of trials assessing second-line treatment, the multiple treatment meta-analysis was considered potentially unreliable.