| Objective: To reevaluate the efficacy and safety of targeted drugs combined with chemotherapy in the treatment of recurrent ovarian cancer by including the latest and most comprehensive data,and to provide reference and basis for the clinical treatment of ROC and improvement of prognosis in different populations.Methods: Nine databases including CNKI,Wanfang,VIP,CBM,Pub Med,Embase,Cochrane Library,Web of science,clinical trial registration center(China + USA),Baidu academic,Google academic,Bing and other search platforms were searched by computer,and gynecological journals such as Chinese Journal of Obstetrics and gynecology were searched by hand to determine the preliminary screening literature.Effective studies were screened according to PICOS criteria.Cochrane risk assessment tool was used to evaluate the quality of the study,objective response rate(ORR),progression free survival(PFS),overall survival(OS)and incidence of adverse reactions rate were used as evaluation indexes to extract basic information and outcome index information.Finally,revman5.3and stata15.1 software were used to calculate RR value Meta analysis was used to analyze the effect quantity(binary data)and HR value(survival data),and descriptive analysis was used to analyze the single study or the study with strong heterogeneity.Result: Sixty-four articles were included,a total of 67 groups of studies.Among them,59 papers(61 groups)were AIs,3 papers(3 groups)were PARPis,and 2 papers(3 groups)were ICIs.Results of the meta-analysis showed that in terms of efficacy,AIs combined with chemotherapy significantly improved objective response rate(RR=1.42,95%CI: 1.36-1.48,P<0.05),progression-free survival(HR=0.74,95%CI: 0.66-0.83,P<0.05)and overall survival(HR=0.92,95%CI: 0.87-0.97,P=0.01);PARPis improved progression-free survival(HR=0.54,95%CI: 0.42-0.69,P<0.05),but didn’t significantly improve the objective response rate(RR=1.04,95%CI: 0.81-1.34,P=0.74)and overall survival(HR=1.18,95%CI: 0.81-1.71,P=0.38);ICIs didn’t improve the objective response rate(RR=1.25,95%CI: 0.83-1.90,P=0.28),progression-free survival(HR=1.10,95%CI: 0.79-1.53,P=0.58)or overall survival(HR=1.00,95%CI:0.80-1.26,P=0.99).In terms of safety,the risk of hypertension,nausea,vomiting,diarrhea,thrombocytopenia and other aspects in the combination group of AIs was significantly higher than that in the chemotherapy alone group(Bevacizumab was mainly associated with hypertension,proteinuria,gastrointestinal events below grade 2,and arteriovenous thromboembolism;VEGFRis is mainly associated with hypertension,diarrhea and thrombocytopenia.Trabanani was mainly characterized by local edema,ascites and hypokalemia.The main manifestations of PARPis were vomiting,thrombocytopenia and anorexia.The mainsymptoms of ICIs group were hypothyroidism,fever and rash.Conclusion: Compared with chemotherapy alone,the application of targeted drugs combined with chemotherapy can significantly improve the treatment effect of ROC patients(e.g.the application of AIs can significantly improve ORR,PFS and OS;PARPis significantly delayed PFS,but also increased the risk of adverse events.Therefore,the actual situation of patients should be fully considered in the clinical diagnosis and treatment,and individualized medication plan should be formulated. |
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