Journal of Clinical Oncology, 2009 ASCO Annual Meeting Proceedings (Post-Meeting Edition).
Vol 27, No 15S (May 20 Supplement), 2009: 5513
© 2009 American Society of Clinical Oncology

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Abstract

Effect of six courses of neoadjuvant chemotherapy on pathological complete remission in advanced ovarian cancer

Medical Oncology Unit S.Orsola-Malpighi Hospital, Bologna, Italy; Obstetrics & Gynaecology Unit, S. Orsola-Malpighi, Bologna, Italy

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Background: The role and the duration of NACT in ovarian cancer are debated. A randomized trial comparing upfront surgery versus 3 courses of NACT (Vergote 2008) demonstrated similar survival, but less morbidity in favor of NACT. However, pathological complete remissions (pCR) were rare and 68% of pts still had lesions greater than 2 cm after 3 courses of NACT. The rate of pCR correlates with a better survival in other tumors, such as breast cancer, and its rate is higher after 6–8 courses of NACT. We conducted this study to verify the incidence of optimal pathological remission after 6 courses of NACT. Methods: Eligible pts had stage IIIC-IV EOC unsuitable for optimal upfront surgery and were treated with 6 cycles of carboplatin AUC 5 and paclitaxel 175 mg/sm, every 3 weeks before surgery. We considered as optimal pathological responders: 1) the pts with absence of cancer cells in surgical specimens, and 2) the pts with no macroscopic residual after surgery and with only small clusters or individual cancer cells in surgical specimens. All the other cases were considered as pathological nonresponders, even if a relevant shrinkage of tumor burden and an optimal surgical debulking were obtained. Results: 35 stage IIIC/IV pts were enrolled; 33 (94%) completed 6 courses of NACT. We observed 18 (51%) pathological responders, and 17 pathological nonresponders (as defined above). Overall, in 20 (57%) pts the goal of no residual tumor after surgery was achieved. After a median follow-up of 21 mo.s, 21 pts progressed (median PFS 15 mo.s) and 10 pts died. As expected, pts with tumor residual after surgery less than 1 cm survived significantly longer than patients with a greater residual (p .0005). The median overall survival was longer in pathological responders (median not reached) vs nonresponders (19.8 mo.s) (p.03). Conclusions: In our study an optimal pathological response occurred in 51% of cases after 6 cycles of carboplatin-paclitaxel, doubling the results described in the literature with 3 courses of NACT. Given that an optimal pathological response correlates with a longer survival compared to a sub-optimal one, a randomized study of 6 vs 3 courses of NACT in order to verify if the increase in pathological response rate will translate into a survival benefit is warranted.

No significant financial relationships to disclose.

Abstract presentation from the 2009 ASCO Annual Meeting