Characteristics and survival of ovarian cancer patients treated with neoadjuvant chemotherapy but not undergoing interval debulking surgery.

Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) confers similar outcomes as primary debulking surgery and chemotherapy. Little is known about patients who receive NACT but do not undergo debulking surgery. Our aim was to characterize these patients. We prospectively identified patients with newly diagnosed stage III/IV ovarian cancer treated with NACT from 7/1/15-12/1/17. Fisher exact and Wilcoxon rank-sum tests were used to compare clinical characteristics by surgical status. The Kaplan-Meier method was used to estimate survival outcomes. Log-rank test and Cox proportional hazards model were applied to assess the relationship of covariates to outcome, and time-dependent covariates were applied to variables collected after diagnosis. Of 224 women who received NACT, 162 (72%) underwent IDS and 62 (28%) did not undergo surgery. The non-surgical group was older (p<0.001), had higher Charlson comorbidity index (CCI; p<0.001), lower albumin levels (p=0.007), lower Karnofsky performance scores (p<0.001), and were more likely to have dose reductions in NACT (p<0.001). Reasons for no surgery included poor response to NACT (39%), death (15%), comorbidities (24%), patient preference (16%), and loss to follow-up (6%). The no surgery group had significantly worse overall survival (OS) than the surgery group (hazard ratio=3.34; 95% confidence interval=1.66-6.72; p<0.001), after adjustment for age, CCI, and dose reductions. A significant proportion of women treated with NACT do not undergo IDS, and these women are older, frailer, and have worse OS. More studies are needed to find optimal therapies to maximize outcomes in this high-risk, elderly population.

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Copyright © 2020. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology.

Déclaration de conflit d'intérêts

There are no potential conflicts of interest related to this work. Outside the submitted work, Dr. Iasonos reports personal fees from Mylan; Dr. Chi reports personal fees from Bovie Medical Co. (medical advisory board and stock options), Verthermia Inc. (medical advisory board and stock options), C Surgeries (shareholder), and Intuitive Surgical Inc (stock ownership); Dr. O'Cearbhaill reports personal fees from Clovis (medical advisory board) and Tesaro (medical advisory board); Dr. Konner reports personal fees from Clovis (guest speaker), AstraZeneca (medical advisory board), and Immunogen (medical advisory board); Dr. Aghajanian reports personal fees from Tesaro (medical advisory board), Immunogen (medical advisory board), Mateon Therapeutics (steering committee) and Cerulean Pharma (medical advisory board), grants and personal fees from Clovis (medical advisory board) and Genentech (steering committee), and grants from AbbVie (steering committee) and Astra Zeneca; and Dr. Long Roche reports personal fees from Intuitive Surgical (travel). The other authors have no potential conflicts of interest to disclose.