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Neoadjuvant Chemotherapy Could Improve Outcomes in Ovarian Cancer

Brandon Scalea
Published: Tuesday, Sep 04, 2018

Wendel R. Naumann, MD

R. Wendel Naumann, MD

Although survival data have not yet indicated superiority for neoadjuvant chemotherapy in patients with ovarian cancer, R. Wendel Naumann, MD, said it remains a reasonable approach as it decreases the morbidity of surgery.

In an interview with OncLive® at the 2018 State of the Science SummitTM on Ovarian Cancer, Naumann, director of Minimally Invasive Surgery in Gynecologic Oncology at Carolinas Medical Center, Atrium Health, discussed the use of neoadjuvant chemotherapy and surgery for patients with ovarian cancer.

OncLive: What is the current role of surgery in the ovarian cancer space?

Naumann: Surgery is obviously an important part of ovarian cancer treatment. The traditional paradigm has been doing surgery first followed by chemotherapy. We have emerging evidence that giving chemotherapy before surgery is a very reasonable option. It has been shown to decrease the morbidity of surgery. We can also improve the optimal and complete resection rate at the time of surgery. The criticism of some of these trials has been that the survival data is a little less than what we expect, but this is because the patients we choose to give neoadjuvant chemotherapy to are patients who do poorly in general.

We have now had 4 randomized trials showing this is a reasonable approach, with at least an equivalent outcome to primary debulking. It’s becoming more of a personal choice. In our institution, we're using minimally invasive surgery to accomplish this, so we can actually reduce the morbidity and mortality from primary surgery.

Is there an optimal neoadjuvant chemotherapy regimen you give your patients?

In the last few years, we have come full circle. Paclitaxel and carboplatin [became available] in 1996, and we have had several trials with other chemotherapy regimens. We found that all of the other ones don't improve outcomes. The new approval of bevacizumab (Avastin) in the upfront setting, particularly for poor-prognosis patients, is probably a good thing in terms of improving their outcomes. That is the patient population we would all agree needs neoadjuvant chemotherapy. We have never been able to show that adding something upfront, whether it's an additional chemotherapy agent or an anti-VEGF agent, has improved survival. However, we can at least improve response rates and increase the amount of time these patients have before the cancer comes back.

Could PARP inhibitors find a place in the neoadjuvant setting?

I don't know about the neoadjuvant setting, but this will at least be true in the upfront setting. The SOLO-1 trial is supposed to be read out shortly; we will see data from it at the 2018 ESMO Congress. The press release has already stated that it's a positive trial. There are other trials ongoing that are testing these drugs in the frontline setting.
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