Interval cytoreductive surgical outcome following administration of standard versus dose-dense neoadjuvant chemotherapy in patients with advanced-stage ovarian cancer

Abstract

Objectives: Given the benefit of dose-dense platinum/taxane chemotherapy compared with standard every-3-week treatment after primary cytoreductive surgery, we sought to evaluate the utilization of dose-dense chemotherapy (DDC) in the neoadjuvant setting. Methods: With institutional review board approval, we identified all stage III/IV ovarian cancer patients who received initial treatment at our institution, and received neoadjuvant chemotherapy (NACT) from January 2008 to May 2013. We excluded cases treated with upfront surgery, low-grade histology, and early-stage disease. Clinicopathologic data were abstracted from medical records. DDC was defined as receiving at least 1 cycle of platinum with weekly paclitaxel. Standard chemotherapy (SC) was defined as receiving no DDC, and at least 1 cycle of an every-3-week platinum/taxane regimen. Appropriate statistical tests were performed. Results: A total of 154 patients received NACT. Of these, 5 (3%) did not undergo interval cytoreductive surgery (IDS) because of progression of disease; all 5 received SC. Of the remaining 149 cases, 23 (15%) received DDC and 126 (85%) received SC. There were no differences in age, CA-125 levels at diagnosis, or baseline albumin between the 2 groups. Seventy-three (49%) of 149 patients had stage IV disease: 64 (51%) of 126 who received SC and 9 (39%) of 23 who received DDC (P = .37). During NACT, the median number of DDC cycles administered was 3 (range, 1–7) compared with 4.5 cycles for the SC patients (range, 3–7) (P = .03). Carcinomatosis was present before IDS in 19 (83%) of 23 DDC patients compared with 109 (87%) of 124 SC patients (P = .74). At the time of IDS, 1 (4%) of 23 DDC patients exhibited a complete clinical response intraoperatively compared with 15 (12%) of 126 SC patients (P = .5). All 7 complete pathologic responses were in the SC group. All patients treated with DDC achieved less than 1 cm visible residual disease at IDS compared with 108 (86%) of 126 who received SC (P = .08). At IDS, 14 (61%) of 23 DDC patients achieved complete gross resection compared with 68 (54%) of 126 SC patients (P = .14). Conclusions: DDC patients had similar clinical features, but received fewer NACT cycles before IDS compared with standard dosing. DDC patients had a similar rate of optimal and complete gross resection at IDS compared with SC, and all DDC patients achieved less than 1 cm visible residual disease. Our data support the consideration of dose-dense neoadjuvant chemotherapy, and future investigation of the long-term oncologic outcomes with this approach.