Three Therapeutic Modalities for Advanced Ovarian Cancer: Real-World Data from a Certified Oncological Center.

Abstract

Introduction: Traditionally, advanced ovarian cancer can be approached from two different therapeutic point of views: a radical surgery aimed at removing all macroscopic tumor followed by a systemic therapy (URS) or a neoadjuvant platinum-based chemotherapy followed by debulking surgery after achieving a response (NACT/IDS). These two options may not be enough, especially when taking into account the current existence of effective and good tolerated maintenance therapies that can also be applied in patients who do not undergo surgery.

Methods: We performed a retrospective analysis of advanced epithelial ovarian cancer patients (FIGO stage IIIC-IV) treated in our certified oncological center over the last 7 years.

Results: Patients allocated to NACT/IDS showed significantly higher performance status measured with the Eastern Cooperative Oncology Group (ECOG) scale on average as well as significantly higher CA125 value upon diagnosis. Histological types or age did not significantly differ. No significative differences were found when comparing the length of the surgery, days at intensive care, or need for blood transfusion, but patients subjected to NACT/IDS were less prone to have "bulky" lymph nodes that needed extirpation or intestinal resections. A complete macroscopic tumor resection was achieved more frequently in the URS group. Patients on the URS group showed significantly higher overall survival (OS) and progression-free survival (PFS). OS and PFS in the nonsurgical group were similar to those in the NACT/IDS group.

Conclusion: Radical surgery should take place whenever success, measured as no-residual tumor, is deemed as a feasible option. Several factors should be taken into place when offering a patient a URS, both patient- (age, performance status, comorbidities) and disease-related. NACT is a good alternative for patients who are not surgical candidates when taking the previously mentioned factors into account. It should be noted that IDS is also aimed at leaving no macroscopic tumor burden, and that not all responses to NACT (objectified by tumor markers or imaging) may be enough to ensure a complete cytoreduction. Moreover, the available maintenance therapies that impact OS could play a relevant role in patients who are not suited for surgery at all, achieving long remission periods with good quality of life. More studies are needed in this field.