Patients with low-grade serous ovarian cancer appear to have worse survival outcomes following treatment with neoadjuvant chemotherapy (NACT).
A version of this article was originally published by CancerNetwork®. This version has been lightly edited.
The use of neoadjuvant chemotherapy (NACT) for less common epithelial ovarian cancers appears to be increasingly prevalent, although primary chemotherapy appears to yield worse survival outcomes compared with primary debulking surgery (PDS) for low-grade serous disease, according to findings from a retrospective cohort study published in JAMA Network Open.
Outcomes were assessed in patient cohorts from the National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) program.
In the NCDB cohort, from 2006 to 2017, the use of NACT underwent relative increases of 58.8% in clear cell carcinomas, from 10.2% to 16.2% (P < .001); 84.4% in low-grade serous carcinomas, from 7.7% to 14.2% (P = .007); and 61.6% in mucinous carcinomas, from 8.6% to 13.9% (P = .07). The interval increase in usage was especially high in older patients with low-grade serous or mucinous carcinomas, younger patients with clear cell carcinomas, patients with minimal comorbidity and clear cell and low-grade serous carcinomas, patients with stage III clear cell carcinomas, and patients with stage IV low-grade serous or mucinous carcinomas.
Patients with clear cell carcinomas had 4-year overall survival (OS) rates of 31.4% with NACT vs 37.7% with PDS (HR, 1.12; 95% CI, 0.95-1.33). The corresponding figures among those with mucinous carcinomas were 27.0% vs 26.7%, respectively (HR, 0.90; 95% CI, 0.68-1.19). Patients with low-grade serous carcinomas receiving NACT had a 4-year OS rate of 56.4% vs 81.0% with PDS (HR, 2.12; 95% CI, 1.55-2.90).
Increases in NACT use also occurred in the SEER cohort among patients treated from 2006 to 2019. The relative increases in the use of NACT were 159% in clear cell carcinomas, from 10.2% to 26.1% (P <. 001), and 147% in low-grade serous carcinomas, from 6.2% to 15.3% (P = .04). The relative increase was 52.1% in mucinous carcinomas (P = .20).
Comparable OS was attained using both NACT and PDS for patients with both clear cell (HR, 0.93; 95% CI, 0.74-1.16) and mucinous (HR, 1.13; 95% CI, 0.72-1.78) carcinomas in the SEER cohort. Additionally, NACT yielded worse OS outcomes than PDS among patients with low-grade serous carcinomas (HR, 3.17; 95% CI, 1.57-6.40).
“A one-size-fits-all concept may not apply in ovarian cancer treatment due to the heterogeneity of the tumors in clinical and biological characteristics; thus, thoughtful interpretation is warranted when extrapolating data derived from common subtypes to less common histologic subtypes,” the authors wrote. “Given a growing enthusiasm for NACT use in less common ovarian carcinomas, developing clinical practice guidelines and consensus to address the role of NACT in less common histologic subtypes would be useful.”
The NCDB cohort included 3880 patients. Of this population, 1829 had clear cell disease, 1156 had low-grade serous disease, and 895 had mucinous disease. The median (IQR) patient age in each respective group was 56 (49-63), 53 (42-64), and 57 (48-66) years. In total, NACT was administered to 13.8%, 10.4%, and 10.6% of patients.
The SEER cohort included 1447 patients, of whom 745, 369, and 333 had clear cell, low-grade serous, and mucinous disease, respectively.
The sequence of treatments was either PDS followed by postoperative chemotherapy or primary chemotherapy followed by interval surgery. The primary end points were trends in and characteristics of NACT use, as well as OS.
Potential limitations to these findings include a variety of unmeasured cofounders such as tumor burden and details of patient comorbidities, as well as various possible selection biases, according to the investigators. Moreover, the investigators only assessed patients from the United States.
“While necessary to address the unmet needs of evidence, prospective trials to evaluate the effectiveness of NACT in less common ovarian cancer subtypes would be likely challenging to conduct due to their rare incidence. National and international collaborations could facilitate the development of such trials,” the investigators concluded. “Barring more data, careful patient selection and shared decision-making are recommended when NACT is considered in these less common carcinomas.”
Reference
Matsuo K, Matsuzaki S, Maeda M, et al. Uptake and outcomes of neoadjuvant chemotherapy among US patients with less common epithelial ovarian carcinomas. JAMA Netw Open. 2023;6(6):e2318602. doi:10.1001/jamanetworkopen.2023.18602
Niraparib Extends PFS, Time to Next Treatment in Patients With EOC, Especially BRCA-Mutated Cases
January 28th 2025First-line maintenance (1LM) niraparib significantly extends progression-free survival (rwPFS) and time to next treatment (rwTTNT) in patients with epithelial ovarian cancer (EOC), with the greatest benefit observed in those considered homologous recombination-deficient (HRd) and those with BRCA-mutated (BRCAm) tumors.
Read More
Real-World Study Highlights PARP Inhibitor Challenges in Ovarian Cancer Care
January 23rd 2025Nearly half of patients with advanced ovarian cancer treated with first-line poly-ADP-ribose polymerase (PARP) inhibitors experienced recurrence in this real-world study, emphasizing the need for enhanced strategies to optimize postrecurrence treatment.
Read More
Gynecologic Oncology Practices Evolve With Surgical De-Escalation Trends
January 21st 2025Researchers identified a 15-year shift toward surgical de-escalation in gynecologic oncology, marked by fewer surgical interventions, increased adoption of minimally invasive techniques, and a greater focus on fertility preservation and sentinel lymph node procedures.
Read More
AI Outperforms Traditional Methods in Predicting Ovarian Cancer Surgery Outcomes
January 19th 2025Artificial intelligence (AI) models, particularly artificial neural networks and machine learning, outperform traditional methods in predicting post–complete cytoreduction outcomes in patients with ovarian cancer, including overall survival, no residual disease, and postoperative complications.
Read More
High HSP60 Expression Signals Poor Prognosis, Aggressive Tumors in Ovarian Cancer
January 16th 2025High heat shock protein 60 (HSP60) expression in patients with ovarian cancer is associated with larger tumors, advanced stages, and worse survival outcomes, highlighting its potential as a prognostic biomarker.
Read More
Niraparib Improves Outcomes in Patients With Stage III EOC, No Visible Residual Disease
January 14th 2025Patients with stage III epithelial ovarian cancer (EOC) and no visible residual disease after primary cytoreductive surgery had significantly longer real-world progression-free survival and time to next treatment when treated with first-line maintenance niraparib compared with those with higher-risk disease.
Read More