Use and Effectiveness of Neoadjuvant Chemotherapy for Treatment of Ovarian Cancer.
Purpose In 2010, a randomized clinical trial demonstrated noninferior survival for patients with advanced ovarian cancer who were treated with neoadjuvant chemotherapy (NACT) compared with primary cytoreductive surgery (PCS). We examined the use and effectiveness of NACT in clinical practice. Patients and Methods A multi-institutional observational study of 1,538 women with stages IIIC to IV ovarian cancer who were treated at six National Cancer Institute-designated cancer centers. We examined NACT use in patients who were diagnosed between 2003 and 2012 (N = 1,538) and compared overall survival (OS), morbidity, and postoperative residual disease in a propensity-score matched sample of patients (N = 594). Results NACT use increased from 16% during 2003 to 2010 to 34% during 2011 to 2012 in stage IIIC disease ( Ptrend< .001), and from 41% to 62% in stage IV disease ( Ptrend< .001). Adoption of NACT varied by institution, from 8% to 30% for stage IIIC disease (P < .001) and from 27% to 61% ( P = .007) for stage IV disease during this time period. In the matched sample, NACT was associated with shorter OS in stage IIIC disease (median OS: 33 v 43 months; hazard ratio [HR], 1.40; 95% CI, 1.11 to 1.77) compared with PCS, but not stage IV disease (median OS: 31 v 36 months; HR, 1.16; 95% CI, 0.89 to 1.52). Patients with stages IIIC and IV disease who received NACT were less likely to have ≥ 1 cm postoperative residual disease, an intensive care unit admission, or a rehospitalization (all P ≤ .04) compared with those who received PCS treatment. However, among women with stage IIIC disease who achieved microscopic or ≤ 1 cm postoperative residual disease, NACT was associated with decreased OS (HR, 1.49; 95% CI, 1.01 to 2.18; P = .04). Conclusion Use of NACT increased significantly between 2003 and 2012. In this observational study, PCS was associated with increased survival in stage IIIC, but not stage IV disease. Future studies should prospectively consider the efficacy of NACT by extent of residual disease in unselected patients.
Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA.
Larissa A
LA
Meyer
Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA.
Angel M
AM
Cronin
Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA.
Charlotte C
CC
Sun
Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA.
Kristin
K
Bixel
Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA.
Michael A
MA
Bookman
Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA.
Mihaela C
MC
Cristea
Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA.
Jennifer J
JJ
Griggs
Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA.
Charles F
CF
Levenback
Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA.
Robert A
RA
Burger
Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA.
Gina
G
Mantia-Smaldone
Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA.
Ursula A
UA
Matulonis
Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA.
Joyce C
JC
Niland
Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA.
David M
DM
O'Malley
Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA.
Alexi A
AA
Wright
D000293:Adolescent; D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D055815:Young Adult