Correspondence: Neoadjuvant Chemotherapy or Primary Debulking Surgery for Stage IIIC Ovarian Cancer

Journal of Clinical Oncology
  
COMPANION ARTICLES

REPLY

• Reply to M.S. Copur et al. December, 28 2016
• Reply to D. Luvero et al. December, 28 2016

ARTICLE CITATION

DOI: 10.1200/JCO.2016.70.7125 Journal of Clinical Oncology - published online before print December 28, 2016

  

To the Editor:

The most recent Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guidelines were published in the October 1, 2016, issue of Journal of Clinical Oncology (JCO).¹ Four phase III clinical trials formed the primary evidence base for the guideline panel recommendations. Authors concluded that in selected women with stage IIIC or IV epithelial ovarian cancer, neoadjuvant chemotherapy and interval cytoreduction was noninferior to primary cytoreduction and adjuvant chemotherapy in terms of overall and progression-free survival. The panel recommended that women with a low likelihood of achieving cytoreduction to less than 1 cm should receive neoadjuvant chemotherapy.
In the November 10, 2016, issue of JCO, Meyer et al² reported the results of a multi-institutional observational study of 1,538 women with stage IIIC to IV ovarian cancer who were treated at six National Cancer Institute–designated cancer centers. The authors examined the neoadjuvant chemotherapy issue and found that patients with stage IIIC or IV disease who received neoadjuvant chemotherapy were less likely to have more than 1 cm postoperative residual disease, an intensive care unit admission, or a hospitalization compared with those who received primary cytoreductive surgery treatment. However, among women with stage IIIC disease who achieved microscopic or less than 1 cm postoperative residual disease, neoadjuvant chemotherapy was associated with decreased overall survival.² The study by Meyer et al is one of the first multi-institutional comparative effectiveness studies that may have included a more representative population of patients than has traditionally been enrolled in randomized clinical trials comparing these two treatment approaches.^3,4 In an editorial in the November 10, 2016, issue of JCO, Vergote et al⁵ concluded that the majority of patients with stage IV ovarian cancer should be treated with neoadjuvant chemotherapy, whereas in patients with stage IIIC disease, careful selection of who can undergo cytoreduction to no residual disease should be performed. With this new information, would the authors of the guideline panel consider an update and clarification to their recent Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guidelines in regard to treatment of Stage IIIC ovarian cancer patients?