The effect of six scheduled cycles of neoadjuvant chemotherapy on prognosis in advanced ovarian cancer

urpose: This study evaluated the appropriate number of cycles of neoadjuvant chemotherapy (NAC) before interval debulking surgery (IDS) in advanced ovarian cancer. Materials and Methods: Cases with advanced ovarian cancer who received a combination of taxane and platinum as NAC and IDS at this institution between 2001 to 2016 were identified. The cases were divided into two groups; patients who received six or four scheduled cycles of NAC (groups A and B, respectively). Results: Thirty-six cases were in group A and 35 cases in group B. Progression-free survival (PFS) and overall survival (OS) in group A were better than those in group B (p = 0.01, < 0.01). In multivariate analysis, six scheduled cycles of NAC was an independent better prognostic factor for PFS (hazard ratio (HR), 0.56, p = 0.04) and OS (HR, 0.39; p = 0.01). Conclusion: In advanced ovarian cancer, six scheduled cycles of NAC demonstrated a better prognosis.

Ovarian carcinoma; Neoadjuvant chemotherapy; Primary debulking surgery; Interval debulking surgery

[1] Permuth­Wey J., Sellers T.A.: “Epidemiology of ovarian cancer”. Methods. Mol. Biol. 2009, 472, 413.

[2] Heintz A.P., Odicino F., Maisonneuve P., Quinn M.A., Benedet J.L., Creasman W.T., et al.: “Carcinoma of the ovary. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer”. Int. J. Gynecol. Obstet. 2006, 95, S161.

[3] Cannistra SA.: “Cancer of the ovary”. N. Engl. J. Med., 2004, 351, 2531.

[4] Colombo P.E., Mourregot A., Fabbro M., Gutowski M., Saint­ Aubert B., Quenet F., et al.: “Aggressive surgical strategies in ad­ vanced ovarian cancer: a monocentric study of 203 stage IIIC and IV patients”. Eur. J. Surg. Oncol. 2009, 35, 135.

[5] Bristow R.E., Tomacruz R.S., Armstrong D.K., Trimble E.L., Montz F.J.: “Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta­ analysis”. J. Clin. Oncol. 2002, 20, 1248.

[6] Chang S.J., Bristow R.E., Ryu H.S.: “Impact of complete cytore­ duction leaving no gross residual disease associated with radical cytoreductive surgical procedures on survival in advanced ovarian cancer”. Ann. Surg. Oncol., 2012, 19, 4059.

[7] du Bois A., Reuss A., Pujade­Lauraine E., Harter P., Ray­Coquard I., Pfisterer J.: “Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analy­ sis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO­OVAR) and the Groupe d’Investigateurs Nationaux Pour les Etudes des Cancers de l’Ovaire (GINECO)”. Cancer, 2009, 115, 1234.

[8] Vergote I., Tropé C.G., Amant F., Kristensen G.B., Ehlen T., John­ son N., et al.: “Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer”. N. Engl. J. Med., 2010, 363, 943.

[9] Kehoe S., Hook J., Nankivell M., Jayson G.C., Kitchener H., Lopes T.: “Primary chemotherapy versus primary surgery for newly di­ agnosed advanced ovarian cancer (CHORUS): an open­label, ran­domised, controlled, non­inferiority trial”. Lancet, 2015, 386, 249.

[10] Stoeckle E., Boubli B., Floquet A., Brouste V., Sire M., Croce S., et al.: “Optimal timing of interval debulking surgery in advanced ovarian cancer: yet to be defined?” Eur. J. Obstet. Gynecol. Reprod. Biol., 2011, 159, 407.

[11] da Costa Miranda V., de Souza Fêde Â.B., Dos Anjos C.H., da Silva J.R., Sanchez F.B., da Silva Bessa L.R., et al.: “Neoadju­ vant chemotherapy with six cycles of carboplatin and paclitaxel in advanced ovarian cancer patients unsuitable for primary surgery: Safety and effectiveness”. Gynecol. Oncol., 2014, 132, 287.

[12] Kang S., Nam B.H.: “Does neoadjuvant chemotherapy increase op­ timal cytoreduction rate in advanced ovarian cancer? Meta­analysis of 21 studies”. Ann. Surg. Oncol., 2009, 16, 2315.

[13] Colombo P.E., Labaki M., Fabbro M., Bertrand M., Mourregot A., Gutowski M., et al.: “Impact of neoadjuvant chemotherapy cycles prior to interval surgery in patients with advanced epithelial ovarian cancer”. Gynecol. Oncol., 2014, 135, 223.

[14] da Costa Miranda V., de Souza Fêde Â.B., Dos Anjos C.H., da Silva J.R., Sanchez F.B., da Silva Bessa L.R., et al.: “Neoadju­ vant chemotherapy with six cycles of carboplatin and paclitaxel in advanced ovarian cancer patients unsuitable for primary surgery: Safety and effectiveness”. Gynecol. Oncol., 2014, 132, 287.

[15] Hazelton D., Nicosia R.F., Nicosia S.V.: “Vascular endothelial growth factor levels in ovarian cyst fluid correlate with malig­ nancy”. Clin. Cancer. Res., 1999, 5, 823.

[16] Burger R.A., Brady M.F., Bookman M.A., Fleming G.F., Monk B.J., Huang H., et al.: “Incorporation of bevacizumab in the primary treatment of ovarian cancer”. N. Engl. J. Med. 2011, 365, 2473.

[17] Klauber N., Parangi S., Flynn E., Hamel E., D’Amato R.J.: “Inhi­ bition of angiogenesis and breast cancer in mice by the microtubule inhibitors 2­methoxyestradiol and taxol”. Cancer. Res., 1997, 57, 81.

[18] Markman M., Liu P.Y., Wilczynski S., Monk B., Copeland L.J., Alvarez R.D., et al.: “Phase III randomized trial of 12 versus 3 months of maintenance paclitaxel in patients with advanced ovar­ ian cancer after complete response to platinum and paclitaxel­based chemotherapy: a Southwest Oncology Group and Gynecologic On­ cology Group trial”. J. Clin. Oncol., 2003, 21, 2460.