Dose-dense regimen versus conventional three-weekly paclitaxel combination with carboplatin chemotherapy in first-line ovarian cancer treatment: a systematic review and meta-analysis

Abstract

Background: Paclitaxel dose-dense regimen has been controversial in clinical trials in recent years. This systematic review and meta-analysis tried to evaluate the efficacy and safety of paclitaxel dose-dense chemotherapy in primary epithelial ovarian cancer. Methods: An electronic search following PRISMA guidelines was conducted (Prospero registration number: CRD42020187622), and then a systematic review and meta-analysis of included literature were initiated to determine which regimen was better. Results: Four randomized controlled trials were included in the qualitative evaluation, and 3699 ovarian cancer patients were included in the meta-analysis. The meta-analysis revealed that the dose-dense regimen could prolong PFS (HR0.88, 95%CI 0.81–0.96; p = 0.002) and OS (HR0.90, 95%CI 0.81–1.02; p = 0.09), but it also increased the overall toxicity (OR = 1.102, 95%CI 0.864–1.405; p = 0.433), especially toxicity of anemia (OR = 1.924, 95%CI 1.548–2.391; p < 0.001), neutropenia (OR = 2.372, 95%CI 1.674–3.361; p < 0.001). Subgroup analysis indicated that the dose-dense regimen could significantly prolong not only PFS (HR0.76, 95%CI 0.63–0.92; p = 0.005 VS HR0.91, 95%CI 0.83–1.00; p = 0.046) but also OS (HR0.75, 95%CI 0.557–0.98; p = 0.037 VS HR0.94, 95%CI 0.83–1.07; p = 0.371) in Asian, and overall toxicity was significantly increased in Asians (OR = 1.28, 95%CI: 0.877–1.858, p = 0.202) compared to non-Asians (OR = 1.02, 95%CI 0.737–1.396, p = 0.929). Conclusion: Paclitaxel dose-dense regimen could prolong PFS and OS, but it also increased the overall toxicity. Therapeutic benefits and toxicity of dose-dense are more obvious in Asians compared to non-Asians, which need to be further confirmed in clinical trials.