Living Evidence Synthesis Updated Report. Hospital de la Santa Creu i Sant Pau. LE-IHD.
Creators: name: Rojas- Reyes, María
name: Vargas, Laura
name: Urrutia, Gerard
Publisher: name: Open Science Framework
Year: 2022
Subjects: subject: Medicine and Health Sciences
subject: advanced ovarian cancer
subject: Continuos update
subject: Epistemonikos L.OVE Platform
subject: Evidence-based medicine
subject: Evidence Synthesis
subject: Inform Health Decisions
subject: Living Evidence
subject: targeted therapy

description: Tittle: Effectiveness and safety of targeted/ biological therapy in patients with advanced ovarian cancer: A living systematic review. Authors: Laura Trujillo ORCID: [0000-0001-7345-604X] Affiliation: Programa Maestría en Investigación Clínica Aplicada a las Ciencias de la Salud. Facultad de Medicina de la Universidad Autónoma de Barcelona. Barcelona, España. Gerard Urrutia ORCID: [0000-0002-8850-0960] Affiliation: Centro Iberoamericano Cochrane, Instituto de Investigación Biomédica De Sant Pau (IIB Sant Pau), Barcelona, España. CIBER de Epidemiología Clínica y Salud Pública (CIBERESP), Barcelona, España. María Ximena Rojas ORCID: [0000-0001-5752-7653] Affiliation: Centro Iberoamericano Cochrane, Instituto de Investigación Biomédica De Sant Pau (IIB Sant Pau), Barcelona, España. Corresponding autor: Laura Trujillo Vargas E-mail address: trujillovargaslaura@gmail.com Postal address: Hospital de la Santa Creu i Sant Pau C/ Sant Antoni Maria Claret, 167. Pavellón 18, planta 0. 08025 Barcelona. España. Funding sources/sponsors: This work is part of a project that has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No MSCA-IF-EF-ST #894990 (to María Ximena Rojas). This work is also supported by the Hospital Universitario Vall d’Hebron. The funders and institutions did not take any part in the development of this study. Conflicts of interest: Authors have declared no conflict of interest. ABSTRACT: Objective This Living Systematic review aims to evaluate the efficacy and safety of targeted therapy (Bevacizumab, Olaparib, Niraparib, Rucaparib) for patients with advanced ovarian cancer. Design Living Systematic review. Database The Epistemonikos-L.OVE platform was used for evidence identification, screening, and selection. This platform has been validated as a repository for COVID-19, and proved to be a highly comprehensive source of evidence. The main search source for the L.OVE platform is the Epistemonikos database (https://www.epistemonikos.org), a comprehensive database that collates information from multiple sources to identify systematic reviews and their included primary studies, including Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, DARE, HTA Database, Campbell database, JBI Database of Systematic Reviews and Implementation Reports, EPPI-Centre Evidence Library. The team maintaining the Epistemonikos-L·OVE platform devised the literature search, using the following approach: i) Identification of terms relevant to the population and intervention components of the search strategy, using Word2vec technology to the corpus of documents available in Epistemonikos Database; ii) Discussion of search terms with methods experts to identify relevant, irrelevant and missing terms, iii) Creation of a sensitive boolean strategy encompassing all the relevant terms. The results of the literature searches were automatically incorporated into the L·OVE platform (automated retrieval) and organized in the corresponding L.OVE of “Targeted therapies for advanced ovarian cancer”. Methods We included only randomized controlled trials (RCT) evaluating the effect of targeted therapies — versus placebo or no treatment in patients with advanced ovarian cancer. Two reviewers independently screened each study for eligibility, extracted data, and assessed the risk of bias. Measures included overall survival, Progression-free survival, toxicity and health related quality of life. We applied the GRADE approach to assess the certainty of the evidence for each outcome. This is the second update report since our previous baseline evidence synthesis report for this question, completed in 04/03/2022 and the first update report completed in 01/06/2022. Results Since the beginning of this living review, searches have retrieved [400] references to the L·OVE platform. We considered [170] as potentially eligible and [131] were reviewed in full text. The baseline report had included [14] Systematic reviews and [6] randomized clinical trial that evaluated the use of targeted therapy compared to the use of placebo in patients with advanced ovarian cancer. Two [2] new systematic reviews, including one [1] new randomized clinical trial, had been included for the previous update (Living Overview). For this new update (Living systematic review), randomized clinical trials were considered, with seven [7] studies (RCTs) in total, including 25 references. For outcome Overall Survival, analysis showed a favorable effect of targeted therapy use between groups for the BRCA population (HR 0.69; 95% CI [0.54 to 0.88]) and Progression-Free Survival outcome, the analysis showed a favorable effect of targeted therapy use between groups for the mixed population (HR 0.47; 95% CI [0.40 to 0.55]), BRCA mutated population (HR 0.29; 95% CI [0.25 to 0.33]), and without BRCA mutation (HR 0.39; 95% CI [0.33 to 0.46]). The GRADE quality of the evidence for the main outcomes was high. Conclusions The use of targeted therapy has a clear favorable effect compared to placebo on outcomes such as overall survival and progression-free survival in advanced ovarian cancer in the entire population, but more clearly in the BRCA-mutated population. Although it is true that a favorable effect on health-related quality of life was reported, they do not have a clinically relevant magnitude; and also no study reported on the outcome of disease-related symptoms. The new emerging evidence detected through the updates (RCT), it was concluded that it would be advisable to continue with the monitoring and ideally make a de novo systematic review which is what has been done in this update. © 2022 Hospital de la Santa Creu i Sant Pau, Spain/ EU H2020, Living Evidence to Inform Health Decisions Project. All rights reserved.