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Abstract
Highlights
►
In patients that have a recurrence and are treated with platinum
chemotherapy, neoadjuvant chemotherapy increased the risk of platinum
resistance.
► The timing of interval surgery should be based on the chemotherapy response, not in a fixed number of chemotherapy cycles.
► The timing of interval surgery should be based on the chemotherapy response, not in a fixed number of chemotherapy cycles.
Objective
Primary
debulking surgery (PDS) has historically been the standard treatment
for advanced ovarian cancer. Recent data appear to support a paradigm
shift toward neoadjuvant chemotherapy with interval debulking surgery
(NACT-IDS) for a subset of women with advanced ovarian cancer. It
remains unresolved whether NACT-IDS increases the risk of platinum
resistance. We compared response to chemotherapy in patients that
received NACT-IDS vs. PDS.
Methods
From
our Cancer Registry database we identified patients with stages IIIC
and IV epithelial ovarian cancer who underwent treatment from January,
2005 to December, 2010. Standard univariate analyses were performed, as
were multivariable analysis with logistic regression. The Kaplan–Meier
method was used to generate survival data.
Results
The
study population consisted of 425 patients, 95 (22.3%) underwent
NACT-IDS and 330 (77.6%) PDS. After the initial platinum-based
chemotherapy, 42 (44.2%) women in the NACT-IDS group were considered to
have platinum resistant disease, compared to 103 (31.2%) in the PDS
group (P = 0.01). When multivariate logistic regression was
used to control for factors independently associated with platinum
resistance, NACT-IDS was no longer associated with an initial increased
risk. However, in women that had a recurrence and were retreated with
platinum-based chemotherapy, 32 (88.8%) in the NACT-IDS group had
developed a recurrence within six months and were considered platinum
resistant, compared to 62 (55.3%) in the PDS (P < 0.001).
Conclusion
In
women with EOC that have a recurrence and are treated again with
platinum-based chemotherapy, NACT-IDS appears to increase the risk of
platinum resistance.
Highlights
►
In patients that have a recurrence and are treated with platinum
chemotherapy, neoadjuvant chemotherapy increased the risk of platinum
resistance.
► The timing of interval surgery should be based on the chemotherapy response, not in a fixed number of chemotherapy cycles.
► The timing of interval surgery should be based on the chemotherapy response, not in a fixed number of chemotherapy cycles.
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