Neoadjuvant Chemotherapy for Advanced Ovarian Cancer
Neoadjuvant Chemotherapy for Advanced Ovarian Cancer
Hello. I am Dr. Maurie Markman from Cancer Treatment Centers of America in Philadelphia, Pennsylvania.
I would like to briefly discuss a very interesting paper and an important paper that appeared in The New England Journal of Medicine, September 2, 2010 issue. This article, entitled "Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer," addressed an extremely important issue in the management of women in this clinical setting.
It has been known for a long time that primary therapy of ovarian cancer can be very beneficial, but there clearly is a group of women who have very advanced disease or perhaps comorbid medical conditions, in whom initial surgery may not be the best option. So the question was, would delaying surgery until after several cycles of chemotherapy negatively affect outcome in this clinical setting, or, in fact, would women equally benefit or perhaps even benefit more from chemotherapy first, followed by surgery?
In this randomized trial, a tremendous effort by a large group of investigators in many countries in many centers, a total of 670 patients were randomly assigned to either undergo surgery first followed by chemotherapy or have a diagnosis of a cancer that appeared to be like ovarian cancer, receive 3 cycles of chemotherapy followed by an interval surgical attempt, and then further chemotherapy.
This trial demonstrated that there was no difference in survival between the patients managed by the 2 approaches, and, in fact, there was overall less morbidity than one might anticipate in this particular patient population with very advanced disease associated with the neoadjuvant approach followed by surgery.
I think the bottom line and very important lesson from this particular trial is that it is an acceptable alternative approach; if a woman appears to have advanced ovarian cancer or is documented to have advanced ovarian cancer, and the gynecologic surgeon feels that the surgery would be difficult because of the extent of the disease or the comorbidity that may be present (significant fluid, low serum albumin because of poor nutrition, large pleural effusions, etc.), it would be very reasonable to give several cycles of chemotherapy and then make an attempt to surgically resect all residual disease followed by further chemotherapy. This can lead to a very meaningful positive outcome and may very well potentiate the effects of the chemotherapy, which would be administered after the surgery.
I would encourage you to read this very important paper because I do think it significantly adds to the management strategies available for women in this clinical setting.
Thank you for your attention.
Hello. I am Dr. Maurie Markman from Cancer Treatment Centers of America in Philadelphia, Pennsylvania.
I would like to briefly discuss a very interesting paper and an important paper that appeared in The New England Journal of Medicine, September 2, 2010 issue. This article, entitled "Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer," addressed an extremely important issue in the management of women in this clinical setting.
It has been known for a long time that primary therapy of ovarian cancer can be very beneficial, but there clearly is a group of women who have very advanced disease or perhaps comorbid medical conditions, in whom initial surgery may not be the best option. So the question was, would delaying surgery until after several cycles of chemotherapy negatively affect outcome in this clinical setting, or, in fact, would women equally benefit or perhaps even benefit more from chemotherapy first, followed by surgery?
In this randomized trial, a tremendous effort by a large group of investigators in many countries in many centers, a total of 670 patients were randomly assigned to either undergo surgery first followed by chemotherapy or have a diagnosis of a cancer that appeared to be like ovarian cancer, receive 3 cycles of chemotherapy followed by an interval surgical attempt, and then further chemotherapy.
This trial demonstrated that there was no difference in survival between the patients managed by the 2 approaches, and, in fact, there was overall less morbidity than one might anticipate in this particular patient population with very advanced disease associated with the neoadjuvant approach followed by surgery.
I think the bottom line and very important lesson from this particular trial is that it is an acceptable alternative approach; if a woman appears to have advanced ovarian cancer or is documented to have advanced ovarian cancer, and the gynecologic surgeon feels that the surgery would be difficult because of the extent of the disease or the comorbidity that may be present (significant fluid, low serum albumin because of poor nutrition, large pleural effusions, etc.), it would be very reasonable to give several cycles of chemotherapy and then make an attempt to surgically resect all residual disease followed by further chemotherapy. This can lead to a very meaningful positive outcome and may very well potentiate the effects of the chemotherapy, which would be administered after the surgery.
I would encourage you to read this very important paper because I do think it significantly adds to the management strategies available for women in this clinical setting.
Thank you for your attention.
