Neoadjuvant chemotherapy with six cycles of carboplatin and paclitaxel in advanced ovarian cancer patients unsuitable for primary surgery: Safety and effectiveness

Miranda, Vanessa da Costa; Fêde, Ângelo Bezerra de Souza; Anjos, Carlos Henrique dos; Silva, Juliana Ribeiro da; Sanchez, Fernando Barbosa; Bessa, Lyvia Rodrigues da Silva; Carvalho, Jesus de Paula; Filho, Elias Abdo; Freitas, Daniel Salvatore de; Estevez-Diz, Maria Del Pilar

doi:10.1016/j.ygyno.2013.12.002

Cited by 75 publications

(66 citation statements)

References 16 publications

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“…The rationale behind this strategy is to achieve a reduction in tumor size and peritoneal dissemination that would consequently elevate the probability of achieving complete tumor resection with less morbidity. For example, up to 30% of these patients may present a complete pathological response [22]. Although the results of a meta-analysis involving 835 patients suggested that this approach was associated with worse oncologic outcomes, recent randomized clinical trials have demonstrated that NACT followed by interval debulking surgery is at least noninferior to the standard therapy [4,7,23].…”

Section: Discussionmentioning

confidence: 99%

“…Although the results of a meta-analysis involving 835 patients suggested that this approach was associated with worse oncologic outcomes, recent randomized clinical trials have demonstrated that NACT followed by interval debulking surgery is at least noninferior to the standard therapy [4,7,23]. Besides, the use of 6 consecutive cycles of chemotherapy instead of the ‘3-surgery-3' scheme can be considered equally effective [22]. This treatment strategy was utilized in the present study to allow more time for planning the surgery and, consequently, to avoid a potential bias.…”

Section: Discussionmentioning

confidence: 99%

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Oncologic Concerns regarding Laparoscopic Cytoreductive Surgery in Patients with Advanced Ovarian Cancer Submitted to Neoadjuvant Chemotherapy

Favero¹,

Macerox

Pfiffer³

et al. 2015

Oncology

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Background: Presently, the use of laparoscopy in advanced ovarian cancer (AOC) is extremely controversial. In the era of neoadjuvant chemotherapy (NACT), endoscopic debulking surgery could be a reasonable alternative for selected patients with primarily unresectable disease. Objectives: To evaluate the feasibility as well as the operative and oncologic safety of laparoscopic debulking surgery in patients with AOC submitted to NACT. Methods: This is a pilot observational study on initially unresectable, high-grade serous ovarian cancer treated with a sequence of 6 cycles of carboplatin and paclitaxel followed by debulking surgery performed by laparoscopy (group 1) or laparotomy (group 2). The inclusion criteria were clinical complete response, CA-125 normalization, imaging without disease in critical areas, and optimal cytoreduction. Results: From January 2011 to March 2014, 21 patients were included. Ten women underwent laparoscopy and 11 laparotomy. No epidemiological or oncologic differences were observed between the groups. No surgery-related casualties, intraoperative complications, conversion to laparotomy, or excessive blood loss or transfusion was detected in the laparoscopic procedures. The mean time of operation was 292 min. The length of hospital stay averaged 3.6 days. Two women in group 1 developed relevant complications. After a mean follow-up of 20 months, the recurrence rates were similar, i.e. 80% in group 1 versus 88% in group 2. Although statistical significance was not reached, the mortality related to cancer was considerably higher (20 vs. 0%; p = 0.086) and the mean chemotherapy-free interval was markedly shorter in group 1 (13.3 vs. 20.5 months; p = 0.288). Conclusion: Laparoscopic optimal debulking surgery after NACT is feasible and effective in selected patients. Nevertheless, laparoscopy was substantially associated with inferior oncologic results. Endoscopic cytoreduction in AOC should be cautiously suggested until larger prospective trials confirm the observed results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Oncologic Concerns regarding Laparoscopic Cytoreductive Surgery in Patients with Advanced Ovarian Cancer Submitted to Neoadjuvant Chemotherapy

Favero¹,

Macerox

Pfiffer³

et al. 2015

Oncology

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“…For advanced or unresectable disease, some authors have recently proposed to increase the number of NAC cycles with the aim of improving the rate of complete resection [14]. Preliminary reports have mentioned that IDS could be delayed after 6 or more cycles without detrimental consequences for longterm survival [15,16]. The purpose of the present study was to evaluate the impact on survival of the number of NAC cycles before the first cytoreductive surgery in a large cohort of advanced EOC patients treated in a specialized center.…”

Section: Introductionmentioning

confidence: 99%

Impact of neoadjuvant chemotherapy cycles prior to interval surgery in patients with advanced epithelial ovarian cancer

Colombo¹,

Labaki²,

Fabbro³

et al. 2014

Gynecologic Oncology

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“…The appropriate number of cycles of NACT remains uncertain. The safety and efficacy of six cycles of paclitaxel/carboplatin (TC) therapy as NACT has been confirmed [Da Costa Miranda et al 2014;Stoeckle et al 2014]. However, the duration of the initial treatment will be longer when ACT is added after NACT-IDS [Milam et al 2011].…”

Section: Clinical Evidence Of Nactmentioning

confidence: 99%

Neoadjuvant chemotherapy in advanced ovarian cancer: latest results and place in therapy

Sato

Itamochi

2014

Ther Adv Med Oncol

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Approximately 70% of women with epithelial ovarian cancer (EOC) are diagnosed with advanced stage disease, which is associated with high morbidity and mortality. The standard approach to treating patients with advanced EOC remains primary debulking surgery (PDS) followed by chemotherapy. EOC is one of the most sensitive of all solid tumors to cytotoxic drugs, with over 80% of women showing a response to standard chemotherapy combined with taxane and platinum. Furthermore, residual disease is a major prognostic factor for survival. On the basis of the clinical features, neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is considered to be an alternative treatment option to standard treatment in patients unable to undergo complete resection during PDS. Noninferiority of NACT-IDS to PDS has been demonstrated in some randomized controlled trials and meta-analyses. NACT would also lead to improved quality of life (QOL) of patients, however there are still problems to be solved in the treatment strategy. The uncertainty of perioperative visual assessment of tumor dissemination after NACT has been reported. In addition, several papers have shown the possibility that NACT induces platinum resistance. Furthermore, a notable risk associated with NACT is that patients with significant side effects and refractory disease will lose the opportunity for debulking surgery. Appropriate selection of the patient cohort for NACT is an important issue. Bevacizumab (Bev) is active in patients with advanced EOC. However, the use of Bev is not recommended in the neoadjuvant setting. Bev has a specific adverse event profile that needs to be considered, especially for surgical management, such as gastrointestinal perforation, hemorrhage, and thromboembolic events. NACT could be an alternative treatment option in patients with stage III or IV EOC. However, further studies are needed to clarify the precise role of NACT in the management of advanced EOC.

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Neoadjuvant chemotherapy with six cycles of carboplatin and paclitaxel in advanced ovarian cancer patients unsuitable for primary surgery: Safety and effectiveness

Cited by 75 publications

References 16 publications

Oncologic Concerns regarding Laparoscopic Cytoreductive Surgery in Patients with Advanced Ovarian Cancer Submitted to Neoadjuvant Chemotherapy

Oncologic Concerns regarding Laparoscopic Cytoreductive Surgery in Patients with Advanced Ovarian Cancer Submitted to Neoadjuvant Chemotherapy

Impact of neoadjuvant chemotherapy cycles prior to interval surgery in patients with advanced epithelial ovarian cancer

Neoadjuvant chemotherapy in advanced ovarian cancer: latest results and place in therapy

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