Review of neoadjuvant chemotherapy characteristics in advanced epithelial ovarian cancer: experience from two cancer centers

Abstract

Background: This study aimed to review the characteristics and survival of patients with Advanced Epithelial Ovarian Cancer undergoing neoadjuvant chemotherapy (NACT) and the impact of timing of surgery and post-operative adjuvant chemotherapy (CCT). Methods: Retrospective multicentre study, of patients with an initial diagnosis of advanced high-grade epithelial ovarian carcinoma, considered inoperable at diagnosis and treated with NACT. Results: Eighty-six patients were analyzed. Fifty-seven underwent surgery, with significantly higher median overall survival (mOS) versus those who were never operated. The percentage of complete surgery (R0) was 74%, with a median progression-free survival (mPFS) of 45 months and mOS of 67 months versus mPFS of 27 months and mOS of 28 months in patients with residual disease. Of the operated patients, 21 underwent 3–4 cycles of NACT and 36 5–6 cycles of NACT, with a mOS of 64 months and 38 months respectively. Patients with almost complete/complete NACT response had significantly improved PFS and OS compared with patients with partial/minimal/absent response. Twenty-two patients underwent 2–3 cycles CCT with no significant differences in terms of PFS or OS. COX regression showed that both the increase in time between NACT and surgery and the chemotherapy response score are related to the risk of death. Conclusions: Complete surgery and Chemotherapy Response Score (CRS) were the most important prognostic factors for survival in this population. The use of CCT showed no advantage in survival outcomes. Prospective studies are needed to evaluate new therapeutic strategies for patients with inoperable ovarian cancer at diagnosis.