Upfront Chemo Does Not Appear To Worsen Ovarian Cancer Survival

Chemotherapy before cytoreductive surgery does not appear to worsen survival in women with advanced-stage epithelial ovarian cancer, according to findings from the National Cancer Database (NCDB).

"While this association doesn't prove the safety of upfront chemotherapy, it is concordant with the randomized-trial data and certainly suggests that no evidence of harm can be measured on the population level," Dr. Alexander Melamed of Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian/Columbia University Irving Medical Center, in New York City, told Reuters Health by email.

"There are now four randomized trials that show starting treatment with chemotherapy results in equivalent long-term cancer outcomes and less surgical morbidity," he said. "Nonetheless, some opinion leaders in gynecologic oncology have worried that too frequent use of this approach could harm patients."

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Dr. Melamed and colleagues used NCDB data to examine and compare time trends in the use of neoadjuvant chemotherapy and median survival among women with advanced-stage epithelial ovarian cancer in the U.S.

Among more than 72,000 women treated between 2004 and 2016, 73.5% were treated with primary cytoreductive surgery and 26.5% were treated with neoadjuvant chemotherapy.

The frequency of primary chemotherapy began increasing by 7.9% per year from 2006 to 2011, and after the first of the randomized trials showing a reduction in surgical morbidity and women assigned to neoadjuvant chemotherapy, the use of neoadjuvant chemotherapy accelerated by 10.3% per year from 2011 to 2016.

By 2016, 45.1% of women received chemotherapy as their initial treatment.

Between 2004 and 2013, median survival increased from 31.1 months to 37.8 months, an increase of 2.1% per year. But changing trends in the use of neoadjuvant chemotherapy were not associated with a change in median survival trend, the researchers report in JAMA Network Open.

Results were similar in a subgroup analysis restricted to women with high-grade serous carcinoma.

"Those surgeons who have continued to worry about the negative impacts of upfront chemotherapy on outcomes in ovarian-cancer patients can be reassured by these data," Dr. Melamed said. "While this study cannot itself demonstrate causality, it adds to the accumulating evidence of the safety of upfront chemotherapy in this setting."

—Will Boggs MD

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