Comparison of the Efficacy of Cisplatin/Paclitaxel Versus Carboplatin/Paclitaxel in Improving Survival and Quality of Life in the Advanced Ovarian Cancer Patient Population: A Systematic Review and Meta-Analysis of Randomized Control Trials

Marium Mansoor; Firzah Shakil; Urba Jalal; Fatimah Shahid; Maira Jamal; Alishba S Ali; Fatima A Abbasi; Hamna Hijazi; Hamza Imran; Sapna Hirani; Aima Javaid; Ahshum Abu Bakar; Abdul Ahad Shah; Giustino Varrassi; Mahima Khatri; Satesh Kumar

doi:10.7759/cureus.51011

Comparison of the Efficacy of Cisplatin/Paclitaxel Versus Carboplatin/Paclitaxel in Improving Survival and Quality of Life in the Advanced Ovarian Cancer Patient Population: A Systematic Review and Meta-Analysis of Randomized Control Trials

Cureus. 2023 Dec 23;15(12):e51011. doi: 10.7759/cureus.51011. eCollection 2023 Dec.

Authors

Marium Mansoor¹, Firzah Shakil², Urba Jalal³, Fatimah Shahid⁴, Maira Jamal⁵, Alishba S Ali⁴, Fatima A Abbasi⁶, Hamna Hijazi⁷, Hamza Imran⁸, Sapna Hirani⁹, Aima Javaid¹⁰, Ahshum Abu Bakar¹¹, Abdul Ahad Shah⁸, Giustino Varrassi¹², Mahima Khatri¹³, Satesh Kumar¹⁴

Affiliations

¹ Medicine and Surgery, Allama Iqbal Medical College, Lahore, PAK.
² Allergy and Immunology, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK.
³ Medical School, Allama Iqbal Medical College, Lahore, PAK.
⁴ Medical School, Rawalpindi Medical University, Rawalpindi, PAK.
⁵ Pediatrics, Hamdard College of Medicine and Dentistry, Karachi, PAK.
⁶ Cardiology, Shifa International Hospital Islamabad, Islamabad, PAK.
⁷ Medical School, Khyber Medical College, Peshawar, PAK.
⁸ Medical School, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK.
⁹ Medical School, Peoples University of Medical and Health Science, Nawabshah, PAK.
¹⁰ Medical School, Fatimah Jinnah Medical University, Lahore, PAK.
¹¹ Medical School, Shalamar Medical and Dental College, Lahore, PAK.
¹² Pain Medicine, Paolo Procacci Foundation, Rome, ITA.
¹³ Medicine and Surgery, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK.
¹⁴ Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK.

Abstract

Ovarian cancer, being one of the prevalent gynecological cancers, warrants a therapy that's both effective and well tolerated. After extensive drug testing, combination regimens with paclitaxel plus platinum-based agents such as cisplatin/carboplatin and taxanes, have shown promising results for advanced ovarian cancer. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the efficacy of two treatment regimens for advanced ovarian cancer: cisplatin/paclitaxel and carboplatin/paclitaxel. PubMed (Medline), Science Direct, and Cochrane Library were searched from inception to March 2023. The meta-analysis included patients with histologically verified International Federation of Gynaecology and Obstetrics (FIGO) stages IIB to IV ovarian carcinoma who received either carboplatin/paclitaxel or cisplatin/paclitaxel. The primary outcomes were progression-free survival (PFS), overall survival (OS), quality of life (QOL), complete response rate (CRR), and partial response rate (PRR). The revised Cochrane Risk of Bias Tool 2.0 was used to assess the quality of the RCTs The five RCTs chosen for this statistical analysis consisted of a total of 2239 participants, with 1109 receiving paclitaxel/cisplatin for treatment and the remaining 1130 receiving carboplatin/paclitaxel. Among all included outcomes, these reported significant findings: QoL (p-value=0.0002), thrombocytopenia (p=<0.00001), neurological toxicity (p-value=0.003), nausea/vomiting (p-value=<0.00001), myalgia/arthralgia (p-value=0.02), and febrile neutropenia (p-value=0.01). We concluded that the carboplatin/paclitaxel doublet endows a better quality of life (QOL) to patients along with significantly fewer gastrointestinal and neurological toxicities when compared with the cisplatin/paclitaxel combination. However, the myelosuppressive effects of carboplatin/paclitaxel remain a point of concern and may require clinical management.

Keywords: advanced ovarian cancer; carboplatin; cisplatin; meta-analysis; paclitaxel.

Publication types

Review