A Cochrane review has concluded that there is little or no difference in survival outcomes between neoadjuvant chemotherapy (NACT) and primary debulking surgery (PDS) for advanced epithelial ovarian cancer.
The review analysed data from five eligible randomised controlled trials which included 1713 women with stage IIIc/IV ovarian cancer randomised to NACT followed by interval debulking surgery (IDS) or PDS followed by chemotherapy.
Pooled data from three studies showed little or no difference in overall survival (1521 women; hazard ratio [HR] 1.06; 95% CI 0.94-1.19, I2=0%; moderate-certainty evidence), while data from four trials showed little benefit in terms of progression-free survival (1631 women; HR 1.02; 95% CI 0.92-1.13, I2=0%; moderate-certainty evidence).
Adverse events, surgical morbidity, and quality of life (QoL) outcomes were poorly and incompletely reported across studies, the authors said.
They say, however, that there may be clinically meaningful differences in favour of NACT with regard to serious adverse effects (grade 3+). The data suggested that NACT may reduce the need for blood transfusion (risk ratio (RR) 0.80; 95% CI 0.64-0.99; low-certainty evidence), venous thromboembolism (RR 0.28; 95% CI 0.09-0.90; low-certainty evidence), and infection (RR 0.30; 95% CI 0.16-0.56; moderate-certainty evidence), compared with PDS.
NACT probably reduces the need for stoma formation (RR 0.43; 95% CI 0.26-0.72; moderate-certainty evidence) and bowel resection (RR 0.49; 95% CI 0.26-0.92; moderate-certainty evidence), and may reduce postoperative mortality (RR 0.18; 95% CI 0.06-0.54: moderate-certainty evidence), the authors determined.
Available data were insufficient to infer the impact on quality of life.
The review concluded that the available moderate-certainty evidence suggests there is little or no difference in primary survival outcomes between PDS and NACT. However, NACT may reduce the risk of serious adverse events, and the need for bowel resection and stoma formation.