Fewer Cycles of Neoadjuvant Chemotherapy Linked to Better Survival in Ovarian Cancer

Receiving fewer cycles of neoadjuvant chemotherapy and undergoing surgery earlier is associated with better survival outcomes in patients with advanced epithelial ovarian cancer, according to a meta-analysis published in the Journal of Gynecologic Oncology.

Researchers found a significant improvement in progression-free survival (PFS) and overall survival (OS) among patients who received 4 or fewer cycles of neoadjuvant chemotherapy. There was a trend toward improved PFS and a significant improvement in OS among patients who received 3 or fewer cycles.

The researchers said more evidence is needed to determine the optimal number of neoadjuvant chemotherapy cycles for these patients.

This meta-analysis included 22 studies encompassing 7005 patients who had advanced epithelial ovarian cancer and were treated with standard neoadjuvant chemotherapy and interval debulking surgery from 1980 to 2020. Most patients (84.12%) had a main diagnosis of serous epithelial ovarian cancer, and the remaining patients (15.88%) had other types, including clear cell, endometrioid, mucinous, or undifferentiated epithelial ovarian cancer.

There were 7 studies (encompassing 1410 patients) that were designed to compare surgery after 3 or fewer cycles of neoadjuvant chemotherapy to surgery after 4 or more cycles. Data from these studies showed a trend toward improved PFS among patients who received 3 or fewer cycles (hazard ratio [HR], 1.13; 95% CI, 0.99-1.29; P =.07) and a significant improvement in OS among those who received 3 or fewer cycles (HR, 1.31; 95% CI, 1.08-1.59; P =.006).

The researchers also looked at 15 studies (encompassing 5595 patients) that were designed to compare surgery after 4 or fewer cycles of neoadjuvant chemotherapy to surgery after 5 or more cycles. Patients who received 4 or fewer cycles had a significant improvement in PFS (HR, 1.22; 95% CI, 1.08-1.36; P <.001) and OS (HR, 1.19; 95% CI, 1.07-1.32; P =.002).

“[O]ur review and meta-analysis revealed that there is not enough evidence to determine the optimal number of NACT [neoadjuvant chemotherapy] treatments before surgery,” the researchers wrote. “Further research in the form of well-designed randomized controlled trials is necessary to address this issue.”

 Reference

Coada CA, Dondi G, Ravegnini G, et al. Optimal number of neoadjuvant chemotherapy cycles prior to interval debulking surgery in advanced epithelial ovarian cancer: A systematic review and meta-analysis of progression-free survival and overall survival. J Gynecol Oncol. 2023;34(6):e82. doi:10.3802/jgo.2023.34.e82

This article originally appeared on Cancer Therapy Advisor