Increased Uptake of Neoadjuvant Chemotherapy Does Not Explain Trend Toward Improved Survival in Advanced Ovarian Cancer

Median overall survival (OS) improved by more than 6 months between 2004 and 2016 for women treated for advanced epithelial ovarian cancer.

Increased use of neoadjuvant chemotherapy during this period was not associated with a change in median survival trend, according to Anne T. Knisely, MD, PGY-3 Resident, Obstetrics and Gynecology, New York-Presbyterian/Columbia University Medical Center, New York City, and colleagues, and published in JAMA Network Open (Knisely AT, et al. JAMA Netw Open. 2020;3:32017517).

The investigators’ retrospective cohort study used the National Cancer Database to identify 72,171 women who received treatment (ie, chemotherapy, surgery, or both) for stage IIIC or IV epithelial ovarian cancer and were diagnosed between January 1, 2004, and December 31, 2016. Mean age of the cohort was 63.0 years. Survival was measured from the time of diagnosis to death or last follow-up.

A total of 53,021 women were treated with primary cytoreductive surgery (73.5%) and 19,150 with neoadjuvant chemotherapy (26.5%) throughout the study period. From 2004 to 2006, 17.6% of participants received neoadjuvant chemotherapy, a rate that accelerated by 10.3% per year starting in 2011 (change of trend, P = .01).

Approximately 75% of the women treated with primary cytoreductive surgery had serious adenocarcinoma compared with approximately 25% treated with neoadjuvant chemotherapy.

The frequency of primary chemotherapy increased by 7.9% per year from 2006 to 2011 (change of trend, P <.001). By 2016, 45.1% of patients received chemotherapy as their initial treatment.

Median OS increased from 31.1 months in 2004 to 37.8 months in 2013. The increased uptake of neoadjuvant chemotherapy over the study period was not associated with a change in median survival trend, which increased by 2.1% per year (change of trend, P = .37). When the analysis was restricted to the subgroup of patients with high-grade serous carcinoma, results were similar: the increase in the use of neoadjuvant chemotherapy starting in 2006 was not associated with a change of trend in median survival, which increased by 2.0% per year (change of trend, P = .21).

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