Frequent Use of Neoadjuvant Chemotherapy May Further Benefit Patients With Advanced Ovarian Cancer

Patients with ovarian cancer who were treated at programs who often used neoadjuvant chemotherapy had greater improvements in short-term mortality and similar gains in median overall survival compared with programs who infrequently utilized this chemotherapy approach, according to recent study results.

In particular, neoadjuvant chemotherapy is given to patients to shrink a tumor before undergoing the main cancer treatment, which is often surgery.

Dr. Alexander Melamed, lead author of this study and assistant professor of obstetrics and gynecology at Columbia University Medical Center, told CURE® that this study assures patients and providers that neoadjuvant therapy is safe and effective for treatment of advanced ovarian cancer — despite past skepticism.

“The importance of this study is that it may help to resolve sort of a long-standing controversy that has existed in gynecologic oncology,” he said. “Despite the fact that there have been multiple randomized trials that have demonstrated that giving (patients) neoadjuvant chemotherapy before you do their surgery for advanced ovarian cancer is a reasonable approach that probably reduces surgical harm, there have been people who have continued to doubt that conclusion despite their being trials.”

The study, which was published in JAMA Oncology, evaluated overall survival in two groups — 19,562 patients (mean age, 64 years) treated in cancer programs with increased adjuvant chemotherapy use and 19,737 patients treated at programs with marginal use of the strategy. Of note, increases in the use of neoadjuvant chemotherapy at the first group of cancer programs were observed between the years 2004 to 2009 and 2010 to 2015 (21.7% to 42.2%). For cancer programs with infrequent use, utilization of neoadjuvant chemotherapy only marginally increased from 20.1% to 22.5%.

Median overall survival time improved similarly in programs with high and low use of neoadjuvant chemotherapy after 2010. Specifically, standard survival time improved from 31.4 months during the years 2004 to 2009 to 36.8 months during 2010 to 2015 for programs that had a low use. In those same years programs that had a high use improved survival time from 31.6 months to 37.9 months.

Melamed mentioned that although this study does not go directly into details on why the use neoadjuvant therapy resulted in these improvements, he has thoughts on why it might be. Many patients with advanced ovarian cancer often go through surgery which can be harmful, and they may not recover enough to receive chemotherapy, which is “the most important treatment for advanced ovarian cancer,” he explained. However, there was no decrease in long-term survival demonstrated in centers that administered neoadjuvant chemotherapy.

“I think when (providers) use neoadjuvant chemotherapy more, you help patients that are going to get potentially very hurt by primary cytoreductive surgery, and you don’t harm the patients that would have done well with it anyway,” he said.

Additionally, there were reductions in early mortality in programs with high use of neoadjuvant chemotherapy. For programs with high use of the strategy, standard six-month mortality rate declined from 16.4% to 12%. In low-use programs, this declined from 16.1% to 14.4%. Researchers found a similar trend found in one-year morality rate, which declined from 25.6% to 19.3% in high-use programs, and from 24.9% to 21.8% in low-use programs.

“I think the significance of this study is that despite the concerns of some skeptics, this study can really reassure both patients and providers that neoadjuvant chemotherapy is an appropriate upfront treatment strategy for patients with advanced ovarian cancer,” Melamed concluded.

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