The impacts of neoadjuvant chemotherapy and of debulking surgery on survival from advanced ovarian cancer

Rosen, Barry P.; Laframboise, Stéphane; Ferguson, Sarah E.; Dodge, Jason; Bernardini, Marcus Q.; Murphy, Joan; Segev, Yakir; Sun, Ping; Narod, Steven A.

doi:10.1016/j.ygyno.2014.07.004

Cited by 104 publications

(112 citation statements)

References 11 publications

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“…Also, it is of interest whether response to chemotherapy can be predicted by TIL infiltrate as is the case in breast cancer (12)(13)(14). In both cohorts, the most pronounced indicator of survival is the result of cytoreductive surgery, with a more distinct effect in the primary surgery cohort, consistent with observations by Rosen and colleagues (19). In line with the immune tumor control hypothesis, one would expect that the influence of TIL infiltration on prognosis is affected by the amount of residual tumor tissue after surgery.…”

Section: Discussionsupporting

confidence: 76%

Treatment Regimen, Surgical Outcome, and T-cell Differentiation Influence Prognostic Benefit of Tumor-Infiltrating Lymphocytes in High-Grade Serous Ovarian Cancer

Wouters

Komdeur

Workel

et al. 2016

Clinical Cancer Research

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Purpose: Tumor-infiltrating lymphocytes (TIL) are associated with a better prognosis in high-grade serous ovarian cancer (HGSC). However, it is largely unknown how this prognostic benefit of TIL relates to current standard treatment of surgical resection and (neo-)adjuvant chemotherapy. To address this outstanding issue, we compared TIL infiltration in a unique cohort of patients with advanced-stage HGSC primarily treated with either surgery or neoadjuvant chemotherapy.Experimental Design: Tissue microarray slides containing samples of 171 patients were analyzed for CD8 þ TIL by IHC.Freshly isolated CD8 þ TIL subsets were characterized by flow cytometry based on differentiation, activation, and exhaustion markers. Relevant T-cell subsets (CD27 þ ) were validated using IHC and immunofluorescence.Results: A prognostic benefit for patients with high intratumoral CD8þ TIL was observed if primary surgery had resulted in a complete cytoreduction (no residual tissue). By contrast, optimal (<1 cm of residual tumor) or incomplete cytoreduction fully abrogated the prognostic effect of CD8 þ TIL. Subsequent analysis of primary TIL by flow cytometry and immunofluorescence identified CD27 as a key marker for a less-differentiated, yet antigen-experienced and potentially tumor-reactive CD8 þ TIL subset. In line with this, CD27 þ TIL were associated with an improved prognosis even in incompletely cytoreduced patients. Neither CD8 þ nor CD27 þ cell infiltration was of prognostic benefit in patients treated with neoadjuvant chemotherapy. Conclusions: Our findings indicate that treatment regimen, surgical result, and the differentiation of TIL should all be taken into account when studying immune factors in HGSC or, by extension, selecting patients for immunotherapy trials. Clin Cancer Res; 22(3); 714-24. Ó2015 AACR.

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Section: Discussionsupporting

confidence: 76%

Treatment Regimen, Surgical Outcome, and T-cell Differentiation Influence Prognostic Benefit of Tumor-Infiltrating Lymphocytes in High-Grade Serous Ovarian Cancer

Wouters

Komdeur

Workel

et al. 2016

Clinical Cancer Research

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“…Then, 45 studies were excluded that had no survival condition associated with NAC or PDS, no comparison between NAC followed by IDS and PDS followed by chemotherapy, no full text, or in which the optimal cytoreduction was not defined as residual disease ≤1 cm [9-12]. Subsequently, 11 studies were excluded in which the FIGO stages were III and IV [3, 13-20] or chemotherapies were administered intraperitoneally [21, 22]. Eventually, 12 studies were included in this meta-analysis, comprising 1 RCT [4], 9 cohort studies [1, 11, 23-29], and 2 case-control studies [5, 30].…”

Section: Resultsmentioning

confidence: 99%

Platinum-Based Neoadjuvant Chemotherapy versus Primary Surgery in Ovarian Carcinoma International Federation of Gynecology and Obstetrics Stages IIIc and IV: A Systematic Review and Meta-Analysis

Yunyun

Xie

Wang

et al. 2017

Gynecol Obstet Invest

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Background/Aim: This study aimed to compare neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS) with primary debulking surgery (PDS) followed by chemotherapy in patients with advanced ovarian carcinoma International Federation of Gynecology and Obstetrics (FIGO) stages IIIc and IV. Methods: PubMed, the Cochrane Library, and manual searches were applied to discriminate potentially eligible studies published before June 30, 2016. Results: A total of 12 comparative studies were finally included; 1,372 patients underwent NAC followed by IDS, and 2,680 patients underwent PDS followed by chemotherapy. For overall pooled estimates, significant between-trial differences were found in the optimal debulking rate, grade 3–5 postoperative adverse reactions, and median overall survival (OS), but no difference was found in the median progression-free survival (PFS). Moreover, a significantly higher incidence was identified in major infections, vascular events, and wound complications for patients in the PDS group. Conclusions: This study suggested that NAC followed by IDS could improve the optimal debulking rate and decrease the postoperative adverse reactions for the current studies, but whether it could improve the OS and PFS compared with PDS followed by chemotherapy in patients with ovarian carcinoma FIGO stages IIIc and IV were still needed to be verified by conducting more randomized controlled trials.

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“…Neoadjuvant chemotherapy is usually platinum-based and administered intravenously; there is no role for intraperitoneal/intravenous therapy in the preoperative patient. A recent study by Rosen et al 40 showed that the long-term survival for patients undergoing primary cytoreduction was far superior to those receiving neoadjuvant chemotherapy and delayed primary surgery (9% vs. 41%, p , .0001). Although selection bias may account for some of this difference, the percentage of longterm survivors is strikingly low in neoadjuvant chemotherapy studies.…”

Section: Surgical Considerations For Intraperitoneal Chemotherapymentioning

confidence: 99%

Update on Intraperitoneal Chemotherapy for the Treatment of Epithelial Ovarian Cancer

Gourley¹,

Walker²,

Mackay³

2016

American Society of Clinical Oncology Educational Book

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The impacts of neoadjuvant chemotherapy and of debulking surgery on survival from advanced ovarian cancer

Cited by 104 publications

References 11 publications

Treatment Regimen, Surgical Outcome, and T-cell Differentiation Influence Prognostic Benefit of Tumor-Infiltrating Lymphocytes in High-Grade Serous Ovarian Cancer

Treatment Regimen, Surgical Outcome, and T-cell Differentiation Influence Prognostic Benefit of Tumor-Infiltrating Lymphocytes in High-Grade Serous Ovarian Cancer

Platinum-Based Neoadjuvant Chemotherapy versus Primary Surgery in Ovarian Carcinoma International Federation of Gynecology and Obstetrics Stages IIIc and IV: A Systematic Review and Meta-Analysis

Update on Intraperitoneal Chemotherapy for the Treatment of Epithelial Ovarian Cancer

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