Meta-analysis Of The Efficacy And Safety Of PARP Inhibitors In The Maintenance Of Recurrent Ovarian Cancer

Objective: To evaluate the efficacy and safety of PARP inhibitors in the maintenance of recurrent ovarian cancer,and to guide the clinical use of recurrent ovarian cancer patients.Methods: All the published randomized controlled trials about the efficacy and safety of PARP inhibitors in the maintenance of recurrent ovarian cancer,were researched through the computerized retrieval of the Chinese Knowledge Network Database(CNKI),Wanfang Database,VIP Database,Embase,CBM,Cochrane Library,PubMed,Web of Science Database,the time limit was set to build the database until December 31,2018.The researchers screened the searched documents in strict accordance with the established inclusion and exclusion criteria,and extracted the basic characteristics of the included documents.The quality of the literature finally included in the study and the extraction of relevant data were carried out in accordance with the bias risk assessment tool of the Cochrane Intervention System Evaluation Manual.The study data included in the study was processed using the Review manager 5.3 software which provided from the Cochrane Collaboration,and the data was heterogeneously analyzed.Survival data included in the study were expressed using HR and its 95% confidence interval(95% CI).For the two categorical variable data,the relative risk(RR)and its 95% CI are used for expression.Results: Finally,4 RCT studies were included,including 1665 patients,including 1070 PARP inhibitors in the experimental group and 595 in the placebo group.The results of the meta-analysis showed that PARP inhibitor maintenance therapy significantly prolonged progression-free survival compared with placebo,the difference was observably statistically significant [HR=0.34,95% CI(0.31-0.38),P<0.00001];PARP inhibitor maintenance therapy increased the objective response rate,the difference was statistically significant [RR = 2.56,95% CI(1.17-5.60),P = 0.02];however,in terms of improved overall survival,there was no observably statistical difference between PARP inhibitor maintenance and placebo groups,[HR=0.88,95% CI(0.64-1.21),P=0.44].The incidence of fatigue,nausea,vomiting,constipation,loss of appetite,anemia,neutropenia,thrombocytopenia,and renal dysfunction in the PARP inhibitor experimental group were higher than those in the placebo group.The incidence of anemia,fatigue,nausea,and vomiting at the level of 3-4 adverse reactions,was also higher than that of the placebo group,and the difference was statistically significant between this two groups(P<0.05).Conclusion: The current study results show that PARP inhibitor maintenance therapy can improve the progression-free survival of patients with recurrent ovarian cancer and increase the objective response rate,but whether it can prolong the overall survival of patients,because lack of more high-quality,large-sample clinical research evidence to support,need further verification;PARP inhibitors will have a series of adverse reactions during clinical treatment including nausea,vomiting,constipation,loss of appetite,fatigue,anemia,neutropenia,thrombocytopenia,etc.,but mostly mild to moderate adverse reactions,still tolerable;the incidence of serious adverse reactions requiring drug intervention is low.