Neoadjuvant chemotherapy without a fixed number of cycles in advanced ovarian cancer not candidates for optimal primary surgery.

Abstract

e15552 Background: Neoadjuvant chemotherapy (N-CT) is a valid alternative for patients with advanced ovarian cancer (AOC) getting similar survival rates to primary debulking surgery (PDS) followed by chemotherapy (CT), with less postoperatory complications (Vergote et al N Engl J Med 2010;363:943-53). Our objective was to evaluate the results of N-CT with a flexible number of cycles according to the clinical and biological evolution of the patients. Methods: 22 patients with stage IIIC-IV AOC, diagnosed by laparoscope or cytology (no primary laparotomy) were registered between January 2007 and September 2011 and treated with N-CT including paclitaxel 175 mg/m2 and carboplatin AUC 6-5 every 3 weeks. The number of cycles of N-CT was dictated by the clinical response, CT scan and CA125 that could allow an interval debulking surgery (IDS) with intent of optimal cytoreduction (R0). After IDS consolidation chemotherapy treatment was given to complete a total of at least 8 cycles. Results: Median age 63.7 years (40 – 80). Histologic types: serous 28%, adenocarcinoma not specified 66%, endometrioid 4.5%. FIGO stage IIIC 57%, IV 43%, Median CA125 at diagnosis: 1744 U (157 – 14483). Mean N-CT cycles 7.8 (4-23). 90.1 % of patients responded before IDS, 2 patients progressed before surgery. Mean CA125 after N-CT was 20.5 U (9-108). 54% of patients achieved complete resection of all macroscopic disease during IDS (R0). 5/22 (22.7%) obtained a pathological complete response (pCR) (no microscopic tumour in all specimens removed). Complications in the postoperatory occurred in 2 patients consisting in suture dehiscence. The range of total number of CT cycles were as follows: <6: 4.54%; 7-8: 31.8%; 9-10: 31.8%, >10: 31.8%. With a mean follow-up of 22.4 months (4 - 57.6), 50% patients live without recurrence. Median PFS has not been reached. Conclusions: N-CT according to clinical and biologic response and not to a fixed number of cycles is an useful tool for patients with stage IIIC-IV AOC not candidates for optimal /R0 PDS, getting a high proportion of patients with optimal /R0 IDS. The complications of IDS are also very limited. pCR as surrogate marker for long-term survival in other tumours, has to be evaluated in AOC.