Impact of neoadjuvant chemotherapy and postoperative adjuvant chemotherapy cycles on survival of patients with advanced-stage ovarian cancer

Abstract

BackgroundThere is currently no consensus regarding the optimal number of chemotherapy cycles to be administered before and after interval debulking surgery (IDS) in patients with advanced ovarian cancer. This study aimed to evaluate the impact of the number of neoadjuvant chemotherapy (NAC) and postoperative adjuvant chemotherapy (POAC) cycles on the survival of patients with advanced ovarian cancer undergoing NAC/IDS/POAC.MethodsWe retrospectively reviewed data from 203 patients who underwent NAC/IDS/POAC at Yonsei Cancer Hospital between 2006 and 2016. All patients underwent taxane plus carboplatin chemotherapy for NAC and POAC. The patient outcomes were analyzed according to the number of NAC, POAC, and total chemotherapy (NAC+POAC) cycles.ResultsPatients who received fewer than 6 cycles of total chemotherapy (n = 8) had poorer progression-free survival (PFS) and overall survival (OS) than those completing at least 6 cycles (p = 0.005 and p<0.001, respectively). Among patients who completed at least 6 cycles of total chemotherapy (n = 189), Kaplan-Meier analysis revealed no significant difference in either PFS or OS according to the number of NAC cycles (1–3 vs. ≥4; p = 0.136 and p = 0.267, respectively). Among patients who experienced complete remission after 3 cycles of POAC (n = 98), the addition of further POAC cycles did not improve the PFS or OS (3 vs. ≥4; p = 0.641 and p = 0.104, respectively).ConclusionIDS after 4 cycles of NAC may be a safe and effective option when completing 6 cycles of total chemotherapy. Furthermore, the addition of more than 3 cycles of POAC does not appear to influence the survival of patients achieving completion remission after 3 cycles of POAC.

Nadir CA-125 serum levels during neoadjuvant chemotherapy and no residual tumor at interval debulking surgery predict prognosis in advanced stage ovarian cancer

“…In support of the guidelines, retrospective studies have shown that patients who received extended NACT cycles had worse outcomes [20,21]. However, other studies have reported contradictory results by demonstrating that IDS after ≥ 6 NACT cycles could be safe and help achieve higher complete resection [22][23][24][25]. The biological nature of a tumor acquiring chemotherapy resistance remains unclear.…”

Long Noncoding RNA LINC01125 Enhances Cisplatin Sensitivity of Ovarian Cancer via miR-1972

“…Currently, the main therapeutic strategy for OC patients with early FIGO stage disease is surgical resection; however, due to the high risk of recurrence (25-30%), the majority of patients receive concurrent adjuvant chemotherapy [2,20]. Usually, surgical resection is not curative for patients with advanced stage OC, and postoperative chemotherapy has been widely accepted as the standard for the treatment of advanced OC [21]. Cisplatin, a well-known antitumor agent that was first synthesized in 1844 by M. Peyrone, has been proven to combat miscellaneous tumors, such as breast cancer, lung cancer, and liver cancer, significantly improving the prognosis of cancer patients [22].…”

Outcomes of Non-High Grade Serous Carcinoma after Neoadjuvant Chemotherapy for Advanced-Stage Ovarian Cancer: Single-Institution Experience

“…After patients were clinically diagnosed as having FIGO stage III or IV, the pathologic diagnosis of epithelial ovarian cancer was made by cytologic evaluation of ascites/pleural effusion, image-guided aspiration biopsy, and diagnostic laparoscopic/laparotomy biopsy. Our institution applied the following selection criteria for the use of NAC as the primary treatment strategy regardless of histologic subtypes: 18 1) pulmonary and/or hepatic parenchymal metastases were observed on initial imaging studies, 2) patients had poor performance status and high operative risk due to medical comorbidities, or 3) optimal debulking surgery (residual disease measuring 1 cm or less) was unsuitable due to high tumor burden (Fagotti score ≥8). 19 …”