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Complete Surgical Cytoreduction Is Vital in Achieving Better Survival Outcomes in Women with Advanced Ovarian Cancer

Conference Correspondent

While ovarian malignancies arising in patients with germline BRCA mutations have been found to be more sensitive to platinum-based treatment, it is not known whether this should be a consideration when deciding between primary surgical and neoadjuvant therapy at the time of diagnosis. Researchers compared preoperative, intraoperative, and survival parameters in patients with and without BRCA germline mutation. Their goal was to determine whether the presence of the mutation led to a better response to neoadjuvant chemotherapy and whether surgery might be less extended to achieve complete surgical cytoreduction.

The study included patients with a diagnosis of advanced ovarian cancer who underwent cytoreductive surgery following neoadjuvant chemotherapy at a single institution between October 2013 and October 2018. Primary outcomes included progression-free survival and overall survival. Secondary outcomes included chemotherapy response score, performance status, and residual disease. Differences between BRCA-positive and BRCA-negative groups were compared.

A total of 168 patients with a diagnosis of advanced ovarian cancer who underwent cytoreductive surgery following neoadjuvant chemotherapy were identified. The overall survival for patients with complete surgical cytoreduction was 48 months compared with 31 months for patients who had an optimal or suboptimal cytoreduction. Performance status and chemotherapy response score were independent predictors for progression-free survival and overall survival, irrespective of BRCA status. Mean progression-free survival and overall survival were not significantly different between BRCA mutation carriers and noncarriers.

Compared with BRCA noncarriers, patients with BRCA mutation did not experience better chemotherapy response or less extended surgery to achieve a complete surgical response following neoadjuvant chemotherapy. In the subgroups of patients with performance status of 2 and those receiving single-agent chemotherapy, patients with BRCA mutation had a shorter overall survival than noncarriers. In the subgroup of patients with a chemotherapy response score of 3, BRCA mutation carriers had a longer progression-free survival and overall survival than noncarriers.

Researchers conclude that complete surgical cytoreduction is vital in achieving better outcomes in women with advanced ovarian cancer, irrespective of BRCA status. They found that a survival benefit is unlikely for patients with poor performance status and those receiving single-agent chemotherapy. A favorable response to neoadjuvant chemotherapy or less extended surgery in patients with a BRCA germline mutation could not be confirmed from the data.

Abstract 330. ESGO 2020.

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