TY - JOUR
T1 - Timing of surgery in patients with partial response or stable disease after neoadjuvant chemotherapy for advanced ovarian cancer
AU - Nitecki, Roni
AU - Fleming, Nicole D.
AU - Fellman, Bryan M.
AU - Meyer, Larissa A.
AU - Sood, Anil K.
AU - Lu, Karen H.
AU - Rauh-Hain, J. Alejandro
N1 - Funding Information:
This work was supported in part by the MD Anderson Ovarian Cancer Moon Shot program, the NIH/NCI under award number P30CA016672 the Ovarian Cancer SPORE at MD Anderson ( CA217685 ), and grants from the NCI ( K08 CA234333 [to J.A.R.-H.] and 5 T32 CA101642 [to K.H.L.]), and American Cancer Society and Frank McGraw Memorial Chair in Cancer Research (to A.K·S.). The funding sources were not involved in the development of our research hypothesis.
Funding Information:
This work was supported in part by the MD Anderson Ovarian Cancer Moon Shot program, the NIH/NCI under award number P30CA016672 the Ovarian Cancer SPORE at MD Anderson (CA217685), and grants from the NCI (K08 CA234333 [to J.A.R.-H.] and 5 T32 CA101642 [to K.H.L.]), and American Cancer Society and Frank McGraw Memorial Chair in Cancer Research (to A.K?S.). The funding sources were not involved in the development of our research hypothesis.
Funding Information:
R.N., K.H.L, and J.A.R-H have nothing to disclose. N.D·F reports personal fees from Tesaro, personal fees from BMS/Pfizer, personal fees from Glaxo Smith Kline, outside the submitted work; B.M.F. and L.A.M report grants from NIH, during the conduct of the study. A.K.S reports grants from NIH Grants during the conduct of the study as well as consulting fees from Merck and Kiyatec, shareholder position in Biopath, other from Kiyatec, and research funding from M-Trap, outside the submitted work.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/6
Y1 - 2021/6
N2 - Objective: The ideal number of neoadjuvant chemotherapy (NACT) cycles prior to interval tumor-reductive surgery (iTRS) for advanced ovarian cancer is poorly defined. We sought to assess survival stratified by number of NACT cycles and residual disease following iTRS in patients with advanced ovarian cancer with partial response (PR) or stable disease (SD) following 3–4 cycles of NACT. Methods: We retrospectively identified patients with advanced high-grade ovarian cancer (diagnosed 2/1/2013 to 2/1/2018) who received at least 3 cycles of NACT and iTRS and had a PR or SD. The population was divided into four groups based on the number of NACT cycles prior to iTRS and residual disease status after (CGR [complete gross residual] or incomplete resection [any amount of residual disease]): 1) 3–4 NACT cycles/CGR, 2) 3–4 NACT cycles/incomplete resection, 3) > 4 cycles/CGR, and 4) >4 cycles/incomplete resection. Overall survival (OS) and progression-free survival (PFS) were estimated using a Kaplan-Meier product-limit estimator and modeled using univariable and multivariable Cox proportional hazards analysis. Results: The cohort consisted of 265 patients with advanced high-grade ovarian cancer with a median age at diagnosis of 65 years. Most were White (87%), had serous histology (89%), and stage IV disease (57%), with an overall CGR rate of 81%. In a multivariable analysis receipt of >4 NACT cycles was not associated with worse PFS or OS (adjusted hazard ratio [aHR] 1.02, 95% CI 0.74–1.42; aHR 1.12, 95% CI, 0.73–1.72 respectively) than was receipt of 3–4 cycles. Any amount of residual disease was associated with worse PFS and OS regardless of the number of NACT cycles (aHR 1.56, 95% CI 1.09–2.22; aHR 2.38, 95% CI 1.52–3.72 respectively). Conclusions: Residual disease was associated with worse survival outcomes regardless of the number of NACT cycles in patients with PR or SD after NACT for advanced high-grade ovarian cancer. These data suggest that the ability to achieve CGR should take precedence in decision-making regarding the timing of surgery.
AB - Objective: The ideal number of neoadjuvant chemotherapy (NACT) cycles prior to interval tumor-reductive surgery (iTRS) for advanced ovarian cancer is poorly defined. We sought to assess survival stratified by number of NACT cycles and residual disease following iTRS in patients with advanced ovarian cancer with partial response (PR) or stable disease (SD) following 3–4 cycles of NACT. Methods: We retrospectively identified patients with advanced high-grade ovarian cancer (diagnosed 2/1/2013 to 2/1/2018) who received at least 3 cycles of NACT and iTRS and had a PR or SD. The population was divided into four groups based on the number of NACT cycles prior to iTRS and residual disease status after (CGR [complete gross residual] or incomplete resection [any amount of residual disease]): 1) 3–4 NACT cycles/CGR, 2) 3–4 NACT cycles/incomplete resection, 3) > 4 cycles/CGR, and 4) >4 cycles/incomplete resection. Overall survival (OS) and progression-free survival (PFS) were estimated using a Kaplan-Meier product-limit estimator and modeled using univariable and multivariable Cox proportional hazards analysis. Results: The cohort consisted of 265 patients with advanced high-grade ovarian cancer with a median age at diagnosis of 65 years. Most were White (87%), had serous histology (89%), and stage IV disease (57%), with an overall CGR rate of 81%. In a multivariable analysis receipt of >4 NACT cycles was not associated with worse PFS or OS (adjusted hazard ratio [aHR] 1.02, 95% CI 0.74–1.42; aHR 1.12, 95% CI, 0.73–1.72 respectively) than was receipt of 3–4 cycles. Any amount of residual disease was associated with worse PFS and OS regardless of the number of NACT cycles (aHR 1.56, 95% CI 1.09–2.22; aHR 2.38, 95% CI 1.52–3.72 respectively). Conclusions: Residual disease was associated with worse survival outcomes regardless of the number of NACT cycles in patients with PR or SD after NACT for advanced high-grade ovarian cancer. These data suggest that the ability to achieve CGR should take precedence in decision-making regarding the timing of surgery.
KW - Interval tumor reductive surgery
KW - Neoadjuvant chemotherapy
KW - Ovarian cancer
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U2 - 10.1016/j.ygyno.2021.04.012
DO - 10.1016/j.ygyno.2021.04.012
M3 - Article
C2 - 33867146
AN - SCOPUS:85104417071
SN - 0090-8258
VL - 161
SP - 660
EP - 667
JO - Gynecologic oncology
JF - Gynecologic oncology
IS - 3
ER -