ASCO & SGO: Neoadjuvant Chemo Now a Standard for Ovarian Cancer

Maurie Markman, MD


August 30, 2016

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Hello. I'm Dr Maurie Markman from Cancer Treatment Centers of America in Philadelphia. I want to briefly discuss a very important paper, a position statement from the American Society of Clinical Oncology and the Society of Gynecologic Oncology, directly addressing the question of neoadjuvant chemotherapy for newly diagnosed advanced ovarian cancer.

This position paper and the data supporting it were just published in the Journal of Clinical Oncology.[1] There's been considerable debate in the gynecologic cancer community regarding the potential clinical utility for neoadjuvant chemotherapy followed by surgery versus primary surgery followed by chemotherapy in the management of advanced ovarian cancer.

The standard teaching, certainly in the gynecologic oncology community in the United States, is that the first effort should be an attempt at optimal surgical cytoreduction, traditionally described as no tumor mass more than 1 cm maximal diameter. Increasingly, this statement is made based upon quite reasonable data, but not from randomized control trials, where the goal should be to leave the patient with no gross residual disease at the end of surgery.

That has been the standard approach—surgery followed by chemotherapy. But there are now several phase 3 randomized trials that have demonstrated essentially equivalent progression-free survival and overall survival with reduced morbidity associated with the use of neoadjuvant chemotherapy versus primary surgical cytoreduction in a setting with quite advanced disease in the peritoneal cavity, when the initial therapy is contemplated.

Of course, this is somewhat of a subjective determination based upon not only the performance status of the patient and the extent of disease, but also on the surgical skills and surgical experience of the individual surgeon, as well as the hospital where the operation is going to be contemplated.

This position statement of the American Society of Clinical Oncology and the Society of Gynecologic Oncology clearly states that use of neoadjuvant chemotherapy followed by surgery is an acceptable therapeutic option based upon the available evidence in a setting where the surgeon and the surgical team do not feel that there is a high probability that the surgery can be performed resulting in that optimal surgical cytoreduction. And in that setting, admittedly, it's somewhat of a subjective determination based upon the skills and the knowledge of that gynecologic oncology surgical team. A very acceptable—in fact, perhaps you might strongly argue, preferable—option would be chemotherapy first followed by surgery where appropriate.

This is an important development, an important position statement from these two outstanding oncology groups regarding management of ovarian cancer. I would encourage anyone with an interest in the management of ovarian cancer to read this important paper, which just appeared in the Journal of Clinical Oncology. I thank you for your attention.


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