Emerging Trends in Neoadjuvant Chemotherapy for Ovarian Cancer

Abstract

Epithelial ovarian cancer remains a leading cause of death amongst all gynecologic cancers despite advances in surgical and medical therapy. Historically, patients with ovarian cancer underwent primary tumor reductive surgery followed by postoperative chemotherapy; however, neoadjuvant chemotherapy followed by interval tumor reductive surgery has gradually become an alternative approach for patients with advanced-stage ovarian cancer for whom primary tumor reductive surgery is not feasible. Decision-making about the use of these approaches has not been uniform. Hence, it is essential to identify patients who can benefit most from neoadjuvant chemotherapy followed by interval tumor reductive surgery. Several prospective and retrospective studies have proposed potential models to guide upfront decision-making for patients with advanced ovarian cancer. In this review, we summarize important decision-making models that can improve patient selection for personalized treatment. Models based on clinical factors (clinical parameters, radiology studies and laparoscopy scoring) and molecular markers (circulating and tumor-based) are useful, but laparoscopic staging is among the most informative diagnostic methods for upfront decision-making in patients medically fit for surgery. Further research is needed to explore more reliable models to determine personalized treatment for advanced epithelial ovarian cancer.

Keywords: epithelial ovarian cancer; interval tumor reductive surgery; laparoscopy scoring; molecular markers; neoadjuvant chemotherapy; optimal cytoreduction; personalized treatment; radiology-based models; targeted therapy; tumor-based genetic markers.

Figure 1

Trends of neoadjuvant chemotherapy use for advanced ovarian cancer in major U.S. observational studies. Adopted and modified from the author’s own work [11]: Gynecol. Oncol. 2021, 160, 32–39. Matsuo, K., et al. Possible candidate population for neoadjuvant chemotherapy in women with advanced ovarian cancer. Trends in the use of neoadjuvant chemotherapy for advanced ovarian cancer in U.S. observational studies. Copyright (2021) with permission from Elsevier. Proportion of NACT with ovarian cancer per calendar year is shown. Only starting point and end point are shown. Y-axis is truncated to 0–70%. * In the trend analysis, neoadjuvant chemotherapy without surgery was included ^† [8]. ^‡ [9]. ^§ [6]. ^¶ [7]. ^# [10]. ^& [11]. Abbreviations: NCDB, National Cancer Database; and SEER, The Surveillance, Epidemiology and End Results; NCI, National Cancer Institute; U.S., United States of America.