Roni Nitecki1, Nicole D Fleming1, Bryan M Fellman2, Larissa A Meyer1, Anil K Sood1, Karen H Lu1, J Alejandro Rauh-Hain3. 1. Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 2. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 3. Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: jarauh@mdanderson.org.
Abstract
OBJECTIVE: The ideal number of neoadjuvant chemotherapy (NACT) cycles prior to interval tumor-reductive surgery (iTRS) for advanced ovarian cancer is poorly defined. We sought to assess survival stratified by number of NACT cycles and residual disease following iTRS in patients with advanced ovarian cancer with partial response (PR) or stable disease (SD) following 3-4 cycles of NACT. METHODS: We retrospectively identified patients with advanced high-grade ovarian cancer (diagnosed 2/1/2013 to 2/1/2018) who received at least 3 cycles of NACT and iTRS and had a PR or SD. The population was divided into four groups based on the number of NACT cycles prior to iTRS and residual disease status after (CGR [complete gross residual] or incomplete resection [any amount of residual disease]): 1) 3-4 NACT cycles/CGR, 2) 3-4 NACT cycles/incomplete resection, 3) > 4 cycles/CGR, and 4) >4 cycles/incomplete resection. Overall survival (OS) and progression-free survival (PFS) were estimated using a Kaplan-Meier product-limit estimator and modeled using univariable and multivariable Cox proportional hazards analysis. RESULTS: The cohort consisted of 265 patients with advanced high-grade ovarian cancer with a median age at diagnosis of 65 years. Most were White (87%), had serous histology (89%), and stage IV disease (57%), with an overall CGR rate of 81%. In a multivariable analysis receipt of >4 NACT cycles was not associated with worse PFS or OS (adjusted hazard ratio [aHR] 1.02, 95% CI 0.74-1.42; aHR 1.12, 95% CI, 0.73-1.72 respectively) than was receipt of 3-4 cycles. Any amount of residual disease was associated with worse PFS and OS regardless of the number of NACT cycles (aHR 1.56, 95% CI 1.09-2.22; aHR 2.38, 95% CI 1.52-3.72 respectively). CONCLUSIONS: Residual disease was associated with worse survival outcomes regardless of the number of NACT cycles in patients with PR or SD after NACT for advanced high-grade ovarian cancer. These data suggest that the ability to achieve CGR should take precedence in decision-making regarding the timing of surgery.
OBJECTIVE: The ideal number of neoadjuvant chemotherapy (NACT) cycles prior to interval tumor-reductive surgery (iTRS) for advanced ovarian cancer is poorly defined. We sought to assess survival stratified by number of NACT cycles and residual disease following iTRS in patients with advanced ovarian cancer with partial response (PR) or stable disease (SD) following 3-4 cycles of NACT. METHODS: We retrospectively identified patients with advanced high-grade ovarian cancer (diagnosed 2/1/2013 to 2/1/2018) who received at least 3 cycles of NACT and iTRS and had a PR or SD. The population was divided into four groups based on the number of NACT cycles prior to iTRS and residual disease status after (CGR [complete gross residual] or incomplete resection [any amount of residual disease]): 1) 3-4 NACT cycles/CGR, 2) 3-4 NACT cycles/incomplete resection, 3) > 4 cycles/CGR, and 4) >4 cycles/incomplete resection. Overall survival (OS) and progression-free survival (PFS) were estimated using a Kaplan-Meier product-limit estimator and modeled using univariable and multivariable Cox proportional hazards analysis. RESULTS: The cohort consisted of 265 patients with advanced high-grade ovarian cancer with a median age at diagnosis of 65 years. Most were White (87%), had serous histology (89%), and stage IV disease (57%), with an overall CGR rate of 81%. In a multivariable analysis receipt of >4 NACT cycles was not associated with worse PFS or OS (adjusted hazard ratio [aHR] 1.02, 95% CI 0.74-1.42; aHR 1.12, 95% CI, 0.73-1.72 respectively) than was receipt of 3-4 cycles. Any amount of residual disease was associated with worse PFS and OS regardless of the number of NACT cycles (aHR 1.56, 95% CI 1.09-2.22; aHR 2.38, 95% CI 1.52-3.72 respectively). CONCLUSIONS: Residual disease was associated with worse survival outcomes regardless of the number of NACT cycles in patients with PR or SD after NACT for advanced high-grade ovarian cancer. These data suggest that the ability to achieve CGR should take precedence in decision-making regarding the timing of surgery.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Margaret I Liang; Emily N Prendergast; Jeanine N Staples; Christine H Holschneider; Joshua G Cohen; Ilana Cass Journal: J Surg Oncol Date: 2019-07-08 Impact factor: 3.454
Authors: M Timmermans; O van der Hel; G S Sonke; K K Van de Vijver; M A van der Aa; R F Kruitwagen Journal: Gynecol Oncol Date: 2019-02-27 Impact factor: 5.482
Authors: Shih-Ern Yao; Lee Tripcony; Karen Sanday; Jessica Robertson; Lewis Perrin; Naven Chetty; Russell Land; Andrea Garrett; Andreas Obermair; Marcelo Nascimento; Amy Tang; Nisha Jagasia; Piksi Singh; Jim Nicklin Journal: Int J Gynecol Cancer Date: 2020-10-29 Impact factor: 3.437
Authors: Helmut Plett; Olga T Filippova; Annalisa Garbi; Stefan Kommoss; Mikkel Rosendahl; Carrie Langstraat; Saurabh Phadnis; Mustafa Zelal Muallem; Thaïs Baert; Dennis S Chi; Giovanni Damiano Aletti; Florin-Andrei Taran; Jan Philipp Ramspott; Oliver Zivanovic; Andreas du Bois; Yukio Sonoda; Ginger Gardner; Alexander Traut; Kara Long Roche; Philipp Harter Journal: Gynecol Oncol Date: 2020-09-09 Impact factor: 5.482
Authors: William E Winter; G Larry Maxwell; Chunqiao Tian; Michael J Sundborg; G Scott Rose; Peter G Rose; Stephen C Rubin; Franco Muggia; William P McGuire Journal: J Clin Oncol Date: 2007-11-19 Impact factor: 44.544
Authors: Benoit You; Patrick Robelin; Michel Tod; Christophe Louvet; Jean-Pierre Lotz; Sophie Abadie-Lacourtoisie; Michel Fabbro; Christophe Desauw; Nathalie Bonichon-Lamichhane; Jean-Emmanuel Kurtz; Philippe Follana; Marianne Leheurteur; Francesco Del Piano; Gwénael Ferron; Gaëtan De Rauglaudre; Isabelle Ray-Coquard; Pierre Combe; Annick Chevalier-Place; Florence Joly; Alexandra Leary; Eric Pujade-Lauraine; Gilles Freyer; Olivier Colomban Journal: Clin Cancer Res Date: 2020-03-24 Impact factor: 12.531
Authors: David Pierce Mysona; Sharad Ghamande; Jin-Xiong She; Lynn Tran; Paul Tran; Bunja J Rungruang; John K Chan; Victoria Bae-Jump; Paola A Gehrig Journal: Ann Surg Oncol Date: 2020-11-05 Impact factor: 5.344