Neoadjuvant chemotherapy was associated with shorter survival vs primary cytoreductive surgery in patients with stage IIIC ovarian cancer, according to a multi-institute observational study reported by Meyer et al in the Journal of Clinical Oncology.
The study involved 1,538 women with stage IIIC to IV ovarian cancer diagnosed between 2003 and 2012 and treated at 6 National Cancer Institute–designated cancer centers. Overall survival, morbidity, and postoperative residual disease were compared with a propensity-score matched sample of 594 patients.
Increased Use of Neoadjuvant Chemotherapy
Overall, 206 of 1,066 patients (19%) with stage IIIC disease and 210 of 472 patients (44%) with stage IV disease received neoadjuvant chemotherapy between 2003 and 2012. Neoadjuvant chemotherapy use increased from 16% during 2003 to 2010 to 34% during 2011 to 2012 in stage IIIC disease (P < .001 for trend) and from 41% to 62% in stage IV disease (P < .001 for trend). Use of neoadjuvant chemotherapy varied among institutions, ranging from 8% to 30% in stage IIIC disease (P < .001) and from 27% to 61% in stage IV disease (P = .007).
In the matched sample, neoadjuvant chemotherapy was associated with significantly shorter median overall survival in stage IIIC disease (33 vs 43 months, hazard ratio [HR] = 1.40, 95% confidence interval [CI] = 1.11–1.77) but not stage IV disease (31 vs 36 months, HR = 1.16, 95% CI = 0.89–1.52) compared with primary cytoreductive surgery. Risks of ≥ 1-cm postoperative residual disease, intensive care unit admission, and rehospitalization (all P ≤ .04) were reduced with neoadjuvant chemotherapy in both stages IIIC and IV disease. However, neoadjuvant chemotherapy was associated with reduced overall survival among women with stage IIIC disease who had microscopic or ≤ 1-cm postoperative residual disease (HR = 1.49, 95% CI = 1.01–2.18).
The investigators concluded: “Use of [neoadjuvant chemotherapy] increased significantly between 2003 and 2012. In this observational study, [primary cytoreductive surgery] was associated with increased survival in stage IIIC but not stage IV disease. Future studies should prospectively consider the efficacy of [neoadjuvant chemotherapy] by extent of residual disease in unselected patients.”
The study was supported by grants from the National Cancer Institute and the Cancer Prevention and Research Institute of Texas.
Larissa A. Meyer, MD, of The University of Texas MD Anderson Cancer Center, is the corresponding author of the Journal of Clinical Oncology article.
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