A comprehensive systematic review and network meta-analysis: the role of anti-angiogenic agents in advanced epithelial ovarian cancer

The efficacy of anti-angiogenic agents (AAAs) in epithelial ovarian cancer (EOC) remains unclear. Therefore, we conducted a systematic review and network meta-analysis (NMA) to synthesize evidence of their comparative effectiveness for improving overall survival (OS) among EOC patients. We searched six databases for randomized controlled trials (RCTs) from their inception to February 2021. We performed an NMA with hazard ratios (HRs) and 95%-confidence intervals (CIs) to evaluate comparative effectiveness among different AAAs in chemotherapy-naive and recurrent EOC. P-score was used to provide an effectiveness hierarchy ranking. Sensitivity NMA was carried out by focusing on studies that reported high-risk chemotherapy-naive, platinum-resistant, and platinum-sensitive EOC. The primary outcome was OS. We identified 23 RCTs that assessed the effectiveness of AAAs. In recurrent EOC, concurrent use of trebananib (10 mg/kg) with chemotherapy was likely to be the best option (P-score: 0.88, HR 1.67, 95% CI 0.94; 2.94). The NMA indicated that bevacizumab plus chemotherapy followed by maintenance bevacizumab (P-score: 0.99) and pazopanib combined with chemotherapy (P-score: 0.79) both had the highest probability of being the best intervention for improving OS in high-risk chemotherapy-naive and platinum-resistant EOC, respectively. AAAs may not play a significant clinical role in non-high-risk chemotherapy-naive and platinum-sensitive EOC.

Automated summary

This study conducted a systematic review and network meta-analysis to evaluate the efficacy of anti-angiogenic agents in epithelial ovarian cancer. The results showed that the concurrent use of trebananib with chemotherapy may be the best option for recurrent EOC. Additionally, bevacizumab plus chemotherapy followed by maintenance bevacizumab and pazopanib combined with chemotherapy were identified as the interventions with the highest probability of improving overall survival in high-risk chemotherapy-naive and platinum-resistant EOC, respectively. However, anti-angiogenic agents may not have a significant clinical role in non-high-risk chemotherapy-naive and platinum-sensitive EOC.