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ICI-based combinations show measurable but heterogeneous activity in platinum-resistant ovarian cancerCombination therapy shows mixed results for advanced ovarian cancer

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Key Takeaway
Note that ICI-based combinations show heterogeneous activity; only pembrolizumab plus weekly paclitaxel showed confirmed OS benefit.

This systematic review and meta-analysis evaluates ICI-based combination therapies for patients with platinum-resistant or platinum-refractory epithelial ovarian, fallopian tube, or primary peritoneal cancer. The analysis synthesizes data from multiple trials to assess objective response rate (ORR), disease control rate (DCR), progression-free survival, and overall survival.

In nonrandomized cohorts, the meta-analysis reported an ORR of 21.9% (95% CI, 13.1% to 34.3%) and a DCR of 59.9% (95% CI, 46.4% to 72.1%). Regarding survival outcomes, the KEYNOTE-B96 trial demonstrated improved progression-free survival (HR, 0.70; 95% CI, 0.58 to 0.84) and overall survival (HR, 0.82; 95% CI, 0.69 to 0.97). However, several other trials including JAVELIN Ovarian 200, EORTC 1508, NRG-GY023, and AGO-OVAR 2.29 did not meet their primary efficacy objectives.

The authors highlight significant heterogeneity in activity across the ICI class. They note that while some combinations show measurable activity, a uniform class effect is not established. Clinical application is limited by the fact that survival benefits were only confirmed for pembrolizumab plus weekly paclitaxel in the KEYNOTE-B96 trial.

How this fits prior evidence

This meta-analysis addresses a gap in understanding the consistency of ICI-based combinations for ovarian cancer. It extends previous evidence regarding pembrolizumab, which was previously shown to improve ORR and OS in HER2-negative advanced gastric or gastroesophageal junction cancer. However, this study highlights that while some specific regimens like pembrolizumab plus paclitaxel show survival benefits, a uniform class effect for ICI combinations is not yet established.

Living with advanced ovarian cancer is incredibly difficult, especially when standard treatments stop working. Doctors are looking closely at immune checkpoint inhibitors (ICI) combined with chemotherapy to find better ways to manage the disease for patients who have developed resistance to platinum drugs.

A review of recent data shows that these combination therapies provide mixed results. In some groups, about 60% of patients saw their disease stay stable or shrink. However, the actual response rate—where the tumor shrinks significantly—was much lower, at around 22%. This means that while the treatment can keep the cancer in check for many, it does not work the same way for everyone.

It is important to note that these results are not uniform across all types of immune therapies. While one specific combination showed a survival benefit in a large study, other trials did not meet their primary goals. Because the data comes from different types of studies, the evidence is currently inconsistent. Patients should talk to their doctors about how these specific findings might apply to their unique situation.

What this means for you:
Combination therapies show some success in controlling ovarian cancer, but results vary significantly between treatments.

Common questions

Does this treatment help with advanced ovarian cancer?

This combination therapy is specifically looked at for patients whose cancer has become resistant to platinum drugs. While some studies showed improved survival and progression-free time, other trials did not meet their primary goals. Because the results are inconsistent across different studies, you should discuss these specific options with your doctor.

Is this treatment safe for patients?

The current data provided in this review does not include specific details on side effects or how well patients tolerated the treatment. Because results vary so much between different types of immune-based combinations, your medical team is the best source for information regarding safety and personal risk.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedAug 2026
View Original Abstract ↓
BackgroundThe clinical value of immune checkpoint inhibitor (ICI)-based combinations in platinum-resistant or platinum-refractory recurrent ovarian cancer remains regimen-dependent and uncertain. We updated the evidence base and separated nonrandomized response evidence from randomized comparative evidence.MethodsPubMed/MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to 23 July 2026, supplemented by reference and citation searching. Eligible reports were peer-reviewed prospective phase II or III trials of an ICI-containing combination in adults with platinum-resistant or platinum-refractory recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer. Front-line, maintenance-only, ICI-monotherapy, retrospective, phase I-only, protocol-only, and mixed platinum-status cohorts without extractable resistant/refractory data were excluded. Objective response rate (ORR) and disease control rate (DCR) from compatible nonrandomized cohorts were synthesized as proportions using a logit random-effects model with Paule–Mandel variance estimation and Hartung–Knapp confidence intervals. Randomized hazard ratios were synthesized descriptively and were not pooled.ResultsTwenty-one eligible prospective reports were included, comprising 14 nonrandomized reports and 7 randomized trials. Of the 14 nonrandomized reports, 13 provided compatible confirmed response data for the pooled ORR analysis, yielding 112 objective responses among 490 participants and a pooled ORR of 21.9% (95% CI, 13.1%–34.3%; I² = 70.7%). The remaining nonrandomized report was retained for narrative synthesis only because it reported an unconfirmed response. Ten nonrandomized reports contributed 211 disease-control events among 354 participants, yielding a pooled DCR of 59.9% (95% CI, 46.4%–72.1%; I² = 71.7%). The seven randomized trials were summarized separately and were not pooled with the nonrandomized reports. KEYNOTE-B96 demonstrated improved progression-free survival (HR, 0.70; 95% CI, 0.58–0.84) and overall survival (HR, 0.82; 95% CI, 0.69–0.97), whereas JAVELIN Ovarian 200, EORTC 1508, NRG-GY023, and AGO-OVAR 2.29 did not meet their primary efficacy objectives.ConclusionsICI-based combinations show measurable but highly heterogeneous activity in platinum-resistant/refractory ovarian cancer. The evidence does not support a uniform class effect: a survival benefit is established for pembrolizumab plus weekly paclitaxel in KEYNOTE-B96, whereas several other randomized strategies were negative. Future trials should prioritize regimen-specific validation, biomarker enrichment, and harmonized toxicity reporting.
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