The efficacy of tyrosine kinase inhibitors combined with chemotherapy for recurrent ovarian cancer: a systematic review and network meta-analysis.

INTRODUCTION: Tyrosine kinase inhibitors (TKIs) are beneficial when administrated alone as adjuvants in women with recurrent ovarian cancer. There is little information regarding the interactions between TKIs and other chemotherapy agents. We conducted a systematic review and meta-analysis to investigate the efficacy and safety of TKI combination therapy versus monochemotherapy. EVIDENCE ACQUISITION: Following the PRISMA statement, we searched for randomized controlled trials in PubMed, Embase, Cochrane, and key conferences. Eight eligible studies, involving 962 women, were included. EVIDENCE SYNTHESIS: Asians favored combination therapy, whereas Whites and African-Americans preferred monochemotherapy. In progression-free survival (PFS) analysis, combination therapy improved PFS (standardized mean difference [SMD]: 0.42, CI95„/o: -2.56 to 3.40) or overall survival (SMD: 0.27, CI95/: -1.56 to 2.10). Objective and cancer antigen (CA)-125 response rates favored combination therapy, whereas complete response rate, stable disease rate, and disease control rate favored monochemotherapy. All-grade (SMD: 0.46, CI_95%: 0.12 to 0.80) and high-grade (SMD: 0.31, CI_95%-0.05 to 0.67) adverse events were associated with combination therapy. It was found that combination therapy caused more adverse events --both all- and high-grade adverse events. In addition, network analysis showed that febrile neutropenia and alopecia were the adverse events most closely associated with combination therapy and monochemotherapy, respectively. CONCLUSIONS: In general, combining TKIs with chemotherapy can moderately improve desired outcomes while causing adverse events. [ABSTRACT FROM AUTHOR]