Delays from neoadjuvant chemotherapy to interval debulking surgery and survival in ovarian cancer.

Delays from primary surgery to chemotherapy are associated with worse survival in ovarian cancer, however the impact of delays from neoadjuvant chemotherapy to interval debulking surgery is unknown. We sought to evaluate the association of delays from neoadjuvant chemotherapy to interval debulking with survival. Patients with a diagnosis of stage III/IV ovarian cancer receiving neoadjuvant chemotherapy from July 2015 to December 2017 were included in our analysis. Delays from neoadjuvant chemotherapy to interval debulking were defined as time from last preoperative carboplatin to interval debulking >6 weeks. Fisher's exact/Wilcoxon rank sum tests were used to compare clinical characteristics. The Kaplan-Meier method, log-rank test, and multivariate Cox Proportional-Hazards models were used to estimate progression-free and overall survival and examine differences by delay groups, adjusting for covariates. Of the 224 women, 159 (71%) underwent interval debulking and 34 (21%) of these experienced delays from neoadjuvant chemotherapy to interval debulking. These women were older (median 68 vs 65 years, P=0.05) and received more preoperative chemotherapy cycles (median 6 vs 4, P=0.003). Delays from neoadjuvant chemotherapy to interval debulking were associated with worse overall survival (HR 2.4 95% CI 1.2 to 4.8, P=0.01), however survival was not significantly shortened after adjusting for age, stage, and complete gross resection, HR 1.66 95% CI 0.8 to 3.4, P=0.17. Delays from neoadjuvant chemotherapy to interval debulking were not associated with worse progression-free survival (HR 1.55 95% CI 0.97 to 2.5, P=0.062). Increase in number of preoperative cycles (P=0.005) and lack of complete gross resection (P<0.001) were the only variables predictive of worse progression-free survival. Delays from neoadjuvant chemotherapy to interval debulking were not associated with worse overall survival after adjustment for age, stage, and complete gross resection.

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Competing interests: Dr. Iasonos reports personal fees from Mylan, outside the submitted work. 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), outside the submitted work. Dr. O'Cearbhaill reports personal fees from Clovis (medical advisory board) and Tesaro (medical advisory board), outside the submitted work. Dr. Konner reports personal fees from Clovis (guest speaker), AstraZeneca (medical advisory board), and Immunogen (medical advisory board), outside the submitted work. 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, outside the submitted work. Dr. Long Roche reports personal fees from Intuitive Surgical (travel), outside the submitted work.