What is the role of neoadjuvant chemotherapy in the treatment of ovarian cancer?

Updated: Aug 10, 2020
  • Author: Andrew E Green, MD; Chief Editor: Yukio Sonoda, MD  more...
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Answer

According to NCCN guidelines, neoadjuvant chemotherapy may be considered for patients with bulky stage III-IV disease ovarian cancer or those who are poor candidates for surgery; however, the NCCN recommends that the assessment of such patients be performed by a gynecologic oncologist. The NCCN notes that upfront debulking surgery remains the treatment of choice in the United States.  [45]

Neoadjuvant chemotherapy for ovarian cancer has been controversial. Although a 2006 meta-analysis concluded that neoadjuvant chemotherapy was associated with worse prognosis, [79]  a 2010 study found that in women with stage III and IV ovarian cancer, neoadjuvant chemotherapy followed by interval surgery provided equivalent outcomes to standard primary surgery followed by chemotherapy. [80]  

Melamed et al reported that in regions of the United States (eg, New England) that rapidly increased the use of neoadjuvant chemotherapy for stage IIIC or IV epithelial ovarian cancer from 2011 to 2012, all-cause mortality through 3 years post-diagnosis dropped significantly in this patient population (hazard ratio [HR], 0.81). In contrast, regions where use of neoadjuvant chemotherapy remained unchanged (eg, the south Atlantic) saw no improvement in mortality (HR, 1.02). [81]

Neoadjuvant chemotherapy comprises two or more cycles of conventional chemotherapy. If the patient has a good response, interval debulking surgery may be performed followed by further chemotherapy.


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