Formal discussant of the JCOG 0602 trial at the ASCO Annual Meeting, Dennis S. Chi, MD, Deputy Chief of the Gynecology Service at Memorial Sloan Kettering Cancer Center, New York, reviewed the strengths and weakness of the study.

“This is the third study to evaluate primary debulking surgery vs neoadjuvant chemotherapy and interval debulking surgery. The bottom line is that the other two studies showed no difference in progression-free survival or overall survival. So far, the idea that you can improve optimal resection and that will translate to improved survival hasn’t panned out.”

Study weaknesses included low rates of optimal debulking (37%) and complete gross resection (12%).

“Progression-free survival and overall survival are immature. The conclusion that if noninferiority is confirmed in 2017, neoadjuvant chemotherapy will become the new standard of care is an overstatement in my view,” Dr. Chi said.

Prospective planned trials comparing these approaches will shed more light on this issue, he continued. Two upcoming studies on primary debulking surgery vs neoadjuvant chemotherapy are an international trial and the U.S. TRUST study, with planned accrual of 800 patients for each investigation. A requirement of both studies is to achieve a complete gross resection rate of 50%, he added.

“In conclusion, neoadjuvant chemotherapy may lead to decreased rates of complications and less surgical invasiveness than primary debulking surgery, but progression-free survival and overall survival are the key endpoints we need to have,” he said. ■

Disclosure: Dr. Chi reported no potential conflicts of interest.