Neoadjuvant Chemotherapy Recommended for Stage IV Tubo-Ovarian Cancer

(December 7, 2018) A study published last month analyzed two clinical trials that sought to determine the best first step for advanced tubo-ovarian cancers, neoadjuvant chemotherapy or debulking surgery. The two studies, EORTC and CHORUS, had a total of 1,220 participants whose median age was 63 years. Both studies included stage IIIC and stage IV epithelial tubo-ovarian cancer but only CHORUS included women who were diagnosed with stages IIIA or IIIB.

About half of the participants were given surgery first and the other half were given neoadjuvant chemotherapy. Those in the EORTC study had a follow up of 9.2 years and those in the CHORUS study had a follow up after 5.9 years. The median overall survival (OS) between the two groups, chemotherapy and surgery, were about the same, 27.6 months and 26.9 months respectively. However, women who were diagnosed with stage IV disease had better OS with neoadjuvant chemotherapy than with upfront debulking surgery, 24.3 months vs 21.2 months respectively.

The author, Ignace Vergote, MD of the University Hospitals Leuven in Belgium concluded that, “our data suggest that neoadjuvant chemotherapy should be the standard of care for most patients with…stage IV tubo-ovarian cancer, and primary surgery should only be undertaken in these stage IV patients in exceptional circumstances with easily resectable disease.”