The adoption of neoadjuvant chemotherapy for advanced epithelial ovarian cancer led to a significant reduction in all-cause mortality within 3 years after diagnosis, according to a recent study published in BMJ (online January 3, 2018; doi:10.1136/bmj.j5463).
While previous research has shown equivalent overall survival and reduced surgical morbidity with neoadjuvant chemotherapy followed by surgery compared with primary cytoreductive surgery, the use of neoadjuvant chemotherapy remains controversial in the United States and has only marginally increased in recent years.
In an effort to estimate the casual effect of increased use of neoadjuvant chemotherapy on all-cause mortality in advanced epithelial ovarian cancer, researchers led by Alexander Melamed, division of gynecologic oncology, department of obstetrics and gynecology, Massachusetts General Hospital, conducted a study of cancer programs throughout the United States. A total of 6034 women with a diagnosis of stage IIIc-IV epithelial disease from regions that rapidly adopted the use of neoadjuvant chemotherapy from 2011 to 2012—New England and east south central regions—or remained unchanged were sampled.
The primary endpoint was all-cause mortality within 3 years of diagnosis. Researchers used Kaplan-Meier curves and proportional hazard models to compare mortality differences between rapidly adopting regions and control regions.
In the rapidly adopting regions, patients treated in 2012 compared with 2011 had a mortality ratio of 0.81 (95% CI, 0.71-0.94) after adjusting for mortality time trends. Contrarily, no differences were observed in the control regions (HR, 1.02; 95% CI, 0.93-1.12).
In comparison with the control regions, more substantial declines in 90-day surgical mortality (7.0%-4.0% vs 5.0%-4.3%; P = .01) and in the proportion of women not receiving surgery and chemotherapy (20.0%-17.4% vs 19.0%-19.%; P = .04) were observed in the rapidly adopting regions.
The association between treatment in regions with greater use of neoadjuvant chemotherapy and lower mortality were confirmed in a cross-sectional analysis (P = .001).
In their concluding remarks, researchers wrote that, “Adoption of neoadjuvant chemotherapy for advanced epithelial ovarian cancer in New England and east south central regions led to a sizable reduction in mortality within 3 years after diagnosis.” Further research should aim to identify how patients who may benefit most can be determined and selected to receive neoadjuvant chemotherapy, they added.—Zachary Bessette