open access: Neoadjuvant Chemotherapy for Advanced Epithelial Ovarian Cancer

open access

Abstract: The historical standard treatment paradigm for advanced epithelial ovarian cancer is surgical staging followed by adjuvant platinum- and taxane-based chemotherapy. It is well established that patients gain a survival advantage when optimal surgical debulking is achieved; surgical intervention that leaves bulky disease does not confer the same advantage. Thus, when optimal cytoreductive surgery is not possible or would lead to excessive morbidity, neoadjuvant chemotherapy followed by interval cytoreductive surgery is employed. There currently is no externally validated predictive model or consensus regarding which patients should be selected for primary debulking surgery vs neoadjuvant chemotherapy. This article reviews the current literature on the use of neoadjuvant chemotherapy as a treatment strategy for patients with advanced epithelial ovarian cancer. 

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Conclusions

PDS remains the standard of care in the United States for the treatment of advanced EOC. However, NACT with ICS is often employed in patients who are deemed too frail to undergo PDS or in whom optimal cytoreduction would require procedures leading to morbidity. Until methods of triaging patients and identifying tumor biology are improved, the decision to perform PDS vs NACT plus ICS remains one way in which providers may be able to alter the trajectory of patient survival in EOC.