Chemotherapy First ‘Not Inferior’ To Primary Surgery For Advanced Ovarian Cancer

Neoadjuvant chemotherapy offers a comparable survival outcome to a primary surgery strategy for advanced ovarian cancer patients and may have morbidity benefits

medwireNews: CHORUS trial results indicate that primary platinum-based chemotherapy with delayed surgery is not inferior to primary surgery followed by chemotherapy for patients with newly diagnosed advanced ovarian cancer.

Median overall survival was 22.6 months for the 251 patients with stage III or IV disease who were randomly assigned to receive primary surgery and 24.1 months for the 253 patients given primary chemotherapy, with a hazard ratio (HR) of 0.87 in favour of the chemotherapy-led schedule.

Moreover, patients who underwent surgery first had a significantly higher rate of grade 3 or 4 postoperative adverse events than those given primary chemotherapy (24 vs 14%) and a significantly greater mortality rate within 28 days of surgery (6 vs <1%).

The CHORUS results are “consistent” with those of the EORTC 55971 trial for advanced ovarian cancer treatment timing, say Matthew Nankivell, from University College London in the UK, and co-investigators.

“These two trials confirm that primary chemotherapy before delayed surgery is an alternative clinical management strategy to primary surgery, which could reduce morbidity in many women with advanced ovarian cancer”, they write in The Lancet.

Acknowledging that median survival duration was “less than expected”, the researchers highlight that the CHORUS patients had poorer prognostic features than women in other trials of advanced ovarian cancer, with greater age (median 65 years), poorly differentiated tumours (77%) and often a poor performance status (19%).

However, the author of an accompanying comment suggests that the CHORUS trial patients received a “low quality of surgical care”, with debulking to less than 1% of residual disease achieved in just 41% of primary surgery patients and 73% of those who underwent primary chemotherapy.

Sokbom Kang, from the National Cancer Center in Goyang, South Korea, therefore questions whether the trial’s findings are applicable to “expert surgeons”.

“Concerns are also increasing that neoadjuvant chemotherapy could be used as an excuse for neglecting maximum surgical efforts or improvement of competent surgical skills”, he writes, emphasising that complete tumour removal was the strongest Prognostic factor in CHORUS patients.

“Neoadjuvant chemotherapy is not, and should not be, the opposite of high-quality surgical care”, Sokbom Kang concludes.

References

Kehoe S, Hook, J Nankivell M, et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet 2015; Advance online publication 19 May. DOI: http://dx.doi.org/10.1016/S0140-6736(14)62223-6

Kang S. Neoadjuvant chemotherapy for ovarian cancer: do we have enough evidence? Lancet 2015; Advance online publication 19 May. DOI: http://dx.doi.org/10.1016/S0140-6736(14)62259-5

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