Clinical Trials of Neoadjuvant Chemotherapy for Ovarian Cancer: What Do We Gain After an EORTC Trial and After Two Addit
- PDF / 208,482 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 89 Downloads / 191 Views
INVITED COMMENTARY
Clinical Trials of Neoadjuvant Chemotherapy for Ovarian Cancer: What Do We Gain After an EORTC Trial and After Two Additional Ongoing Trials Are Completed? Keiichi Fujiwara & Akira Kurosaki & Kosei Hasegawa
Published online: 16 March 2013 # Springer Science+Business Media New York 2013
Abstract The aim of neoadjuvant chemotherapy is to reduce the tumor volume or spread of the disease before the main treatment, and it could possibly make the main procedures easier or less invasive. Although the standard therapeutic strategy for advanced ovarian cancer is a maximum primary debulking surgery followed by chemotherapy, a European Organisation for Research and Treatment of Cancer (EORTC) prospective randomized trial demonstrated that neoadjuvant chemotherapy followed by interval debulking surgery was not inferior to the standard procedure. This study raised a number of controversies, particularly regarding the quality of debulking surgery. To solve the questions, we need to wait for the results of two additional ongoing randomized trials. However, the results of those two trials must be carefully assessed, because the quality of debulking surgery would significantly affect survival, and may make the interpretation of the trial results more confusing and difficult.
Introduction The treatment outcome of ovarian cancer is very poor, because this disease is most commonly diagnosed in advanced stages [1]. Since 1999, the current standard treatment strategy for advanced ovarian cancer is so-called maximum effort of primary debulking surgery (PDS) followed by taxane plus carboplatin chemotherapy. To improve the therapeutic effect, new agents such as bevacizumab [2, 3] and intraperitoneal therapy [4] have been investigated. At the same time, K. Fujiwara (*) : A. Kurosaki : K. Hasegawa Department of Gynecologic Oncology, Saitama Medical School International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama 350-1298, Japan e-mail: [email protected]
the attempt to reduce the patient’s burden has been investigated. This concept is important if the clinical outcome is the same regardless of the intensity or aggressiveness of the main therapy. These less invasive treatments will potentially improve the quality of life of patients. Neoadjuvant chemotherapy (NACT) is one of these approaches. In the Fourth Ovarian Consensus Conference statement [5], it was concluded that “delayed primary surgery following NACT is an option for selected patients with stage IIIC and stage IV ovarian cancer as included in EORTC 55971 [6],” although this was the only issue among the consensus conference where total consensus was not reached. In this review, we discuss the concept, current status, and future perspectives of NACT in advanced ovarian cancer, focusing particularly on the quality of debulking surgery.
Neoadjuvant Chemotherapy The general concept of NACT is to administer chemotherapy before the main treatment such as surgery or radiation therapy. The purpose of this strategy is to reduce the tumor size or extent o
Data Loading...
