Ovarian cancer meta-analysis: similar survival for neoadjuvant chemotherapy, primary surgery

  • Cochrane Database Syst Rev
  • 13 Nov 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) and primary debulking surgery (PDS) followed by chemotherapy showed a similar rate of survival in patients with advanced epithelial ovarian cancer.
  • NACT may reduce the risk of serious perioperative adverse events and the need for bowel resection and stoma formation.

Why this matters

  • NACT/IDS may be an alternative to PDS followed by chemotherapy in women with advanced disease.

Study design

  • Meta-analysis of 5 randomized controlled trials involving 1713 patients with advanced ovarian cancer, randomly assigned to NACT followed by IDS or PDS followed by chemotherapy.
  • Funding: NIHR Cochrane Programme Grant Scheme, UK.

Key results

  • NACT and PDS groups showed no difference in OS (HR, 1.06; P=.37) or PFS (HR, 1.02; P=.69).
  • In the NACT and PDS groups:
    • 36% and 15% of patients had no macroscopic residual disease, respectively; and
    • 31% and 22% had optimal debulking, respectively.
  • NACT had lower risk of blood transfusion (risk ratio [RR], 0.80; P=.04), venous thromboembolism (RR, 0.28; 95% CI, 0.09-0.90), and infection (RR, 0.30; P=.03).
  • Stoma formation (RR, 0.43; 95% CI, 0.26-0.72) and bowel resection (HR, 0.49; P=.03) were less likely in NACT group.
  • No difference was observed in severe gastrointestinal adverse events.

Limitations

  • Moderate-certainty evidence.