Lack of Proof from Randomized Trials for the
Superiority of Platinum Combinations Over Single Agent Alkylators
The Advanced Ovarian Trialists Group has published a series of landmark meta-analyses which have summarized the overall conclusions from prospective, randomized trials in ovarian cancer. In their 1991 publication, entitled "Chemotherapy in advanced ovarian cancer; an overview of randomized clinical trials" (Br Med J 303:884-893,'91) they concluded that (I quote) "no conclusions could be made." Which is to say that nothing had ever been proven to be better than anything else, save for the equivalency of cisplatin and carboplatin, with regard to long term survival. In their most recent update (Br J Cancer 78:1479-1487,'98) they did not present their updates on the studies of platinum combinations versus single agent alkylators, but stated that the data were available upon request (from Dr. L. Stewart, Head, Meta-analysis group, MRC Clinical Trials Unit, 222 Euston Road, London, NW1 2DA, UK. e-mail: firstname.lastname@example.org).
I wrote to Dr. Stewart and received several pages of data, showing no difference between the survival curves between patients treated initially with platinum combinations versus single agent alkylators, nor any difference between hazard ratios between platinum combination therapy versus single agent alkylators (HR = 0.934, 95% confidence interval 0.831 to 1.049, p = 0.246).
And yet THREE different review papers (plus the lecture to which a link was provided) maintain that the superiority for intial therapy with platinum combinations has been proven! Quoting the studies of the Advanced Ovarian Trialists Group! I don't think so. Show me the data.