The use of neoadjuvant chemotherapy in patients with advanced epithelial ovarian cancer may reduce mortality

1. In this comparative study, patients with advanced epithelial ovarian cancer who received neoadjuvant chemotherapy were found to have reduced early morbidity or mortality.

Evidence Rating Level: 2 (Good)

The optimal sequencing of surgery and chemotherapy for advanced epithelial ovarian cancer remains an important clinical question, particularly regarding whether increased use of neoadjuvant chemotherapy (NACT) affects long-term survival. This comparative effectiveness study examined whether cancer programs that adopted NACT more extensively after publication of randomized trial evidence experienced differences in 10-year overall survival compared with programs with little change in NACT use. The investigators used the National Cancer Database to identify patients with stage IIIC or IV epithelial ovarian cancer diagnosed between 2004 and 2015, with follow-up through December 2023. The analysis included 17,004 patients treated at 319 low-NACT-use programs and 17,611 patients at 319 high-use programs, with a mean age of 63.8 years. A difference-in-differences design compared programs with large versus minimal increases in NACT utilization before and after publication of an RCT supporting NACT as a noninferior treatment strategy. NACT use increased from 21.5% to 42.8% at high-use programs compared with only 20.3% to 22.7% at low-use programs, producing a difference-in-differences estimate of 18.9 percentage points (95% CI, 16.6-21.2). Despite this divergence in treatment strategy, standardized 10-year survival increased similarly in both groups, from 15.6% to 20.0% at high-use programs and from 15.1% to 19.1% at low-use programs. The corresponding difference-in-differences estimate for 10-year survival was only 0.3 percentage points (95% CI, −0.8 to 1.6), while the difference in 10-year restricted mean survival time was 0.7 months (95% CI, −0.8 to 2.1). Thus, greater program-level adoption of NACT was not associated with either better or worse 10-year survival in this analysis. The authors concluded that these findings extend previous evidence suggesting that increased use of NACT can reduce early morbidity or mortality without compromising long-term survival.

Click here to read this study in JAMA Network Open

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