Neoadjuvant chemotherapy in patients with advanced ovarian cancer: preoperative response evaluation – Results from a prospective mutlicenter phase II study

Purpose

To evaluate the response to neoadjuvant chemotherapy (NAC) in patients with epithelial ovarian cancer (EOC).

Patients and Methods

Patients with FIGO stage IIIC or IV EOC and an ascites volume of ≥ 500ml were randomly assigned to receive three (A1) or two (A2) of six cycles of carboplatin and docetaxel IV preoperatively. Baseline serum CA 125 levels were measured, and computed tomography (CT) scans and vaginal ultrasounds were performed to determine target lesions and the volume of ascites. This was repeated after two, or two and three courses of NAC respectively. The primary outcome measure was the preoperative reduction of ascites volume. Secondary outcome measures were the evaluation of overall response, residual tumor, and perioperative morbidity and mortality.

Results

43 patients underwent cytoreductive surgery after two cycles and 40 patients after three cycles of NAC. 14 patients (8 A1; 6 A2) had a persistent ascites volume ≥ 500ml. A decline of the CA 125 level from baseline to 50% or less was observed in 33 patients (A1) and 29 patients (A2). CT scan results showed partial response (PR) in 26 patients (13 A1; 13 A2). Persistent ascites was associated with poorer progressionfree survival (PFS), the decline of CA 125 was associated with favorable PFS and overall survival (OS). Optimal cytoreduction (≤ 1 cm residual disease) was achieved in 62 patients (30 A1, 32 A2).

Conclusions:

Ascites volume reduction and CA 125 decline are appropriate response criteria. Cytoreductive surgery after NAC can achieve a high percentage rate of “optimal“ residual disease. Future phase III studies have to be awaited before offering NAC outside of clinical protocols.

CA 125 - CT - ascites - chemotherapy - ovarian cancer