- 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.
- 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.
- 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.
- Moderate-certainty evidence.