D03Role of targeted therapy in ovarian cancer treatment: a systematic review and meta-analysis of randomized trials

Introduction: Ovarian cancer is the leading cause of death among gynaecological tumors. By results of several clinical trials, new gold-standard for the first line treatment is represented by the combination of carboplatin, paclitaxel and bevacizumab. In the era of personalized medicine, there is still uncertain on the impact of several targeted agents evaluated in the management of this disease. To clarify the weight of this class of agents in common clinical practice a meta-analysis was preformed. Patients and methods: Clinical trials were selected by searching “Pubmed” database and abstracts from major cancer meetings within 2004-2014 time frame. Primary end point was overall survival (OS), secondary end-points were progression free survival (PFS) and response rate (RR). Hazard ratios (HRs) of OS and PFS, with confidence intervals, odds-ratios (ORs) of RR, and risk ratios of grade 3-4 toxicity rates, as presented in retrieved studies, were extracted and used for current analysis. Meta-analysis was carried out by the fixed effect and random effect. Results: 36 randomized trials for a total of 13.395 patients were selected and included in the final analysis. In the targeted therapy arm a benefit in terms of OS (pooled HR: 0.91; 95%CI: 0.83-0.98; p = 0,016), particularly in second line of treatment (pooled HR: 0.88; 95%CI: 0.79-0.98) and in anti-angiogenetic agents (pooled HR: 0.86; 95%CI: 0.76-0.98), respectively, was observed. As far as platinum status setting, a significant advantage for targeted therapy in platinum-resistant subgroup (pooled HR: 0.86; 95%CI: 0.75-0.97) was also found. These data were confirmed in term of PFS and RR. Among toxicities, no difference was reported in the evaluated arms. Conclusions: Targeted therapy improves survival in ovarian cancer patients. In particular we underlined the role of this important strategy in the platinum-resistant setting that represents the pain in the neck in ovarian cancer management.