High/Low Neoadjuvant Chemotherapy Administration Yields Comparable OS Benefit in Advanced Ovarian Cancer

A comparative study found that those who received low-use neoadjuvant chemotherapy compared with a high-use therapy had similar improvements in overall survival (OS), with high-use patients experiencing larger declines in short-term mortality in advanced ovarian cancer, according to findings from a comparative study published in JAMA Oncology.

The median OS with high use of neoadjuvant chemotherapy increased from 31.6 months to 37.9 months, with low use yielding an increase of 31.4 months to 36.8 months. Additionally, 1-year mortality rates declined in programs that high (25.6% to 19.3%) and low (24.9% to 21.8%) neoadjuvant chemotherapy. The 6-month mortality rate in the high-use group was 16.4% prepublication and 12.0% post-publication and 16.1% and 14.4%, respectively in the low-use cohort. The 1-year mortality rates in the respective groups were 24.6% and 19.3%, as well as 24.9% and 21.8%, respectively.

“The present results mirror those of 4 randomized clinical trials that compared neoadjuvant chemotherapy with primary surgery for advanced ovarian cancer. Each trial found that neoadjuvant chemotherapy reduced the risk of surgical morbidity and mortality without compromising long-term overall survival. A fifth randomized clinical trial investigating this question has completed patient enrollment, and results are expected by 2023,” investigators of the study wrote.

Investigators identified 19,562 patients who were treated with high-use and 19,737 patients who were treated with low-use neoadjuvant chemotherapy. A total of 332 cancer programs helped to increase the use of neoadjuvant therapy from 21.7% across 2004 to 2009 to 42.2% from 2010 to 2015. Additionally, 332 cancer programs helped to increase the use of low-use neoadjuvant chemotherapy from 20.1% to 22.5% across the same time periods.

Additional findings from the study indicated that the median 30-day post-operative mortality rate was 3.3% pre-publication and 1.6% post-publication in the high-use group and 3.2% and 2.4% in the low-use group, respectively. Additionally, the 90-day post-operative mortality rates in both respective groups were 7.3% and 4.3%, as well as 7.8% and 6.3%, respectively.

When restricting the primary analysis to only include high-use programs in the highest quartile of observed compared with expected neoadjuvant chemotherapy use, investigators identified a group of programs that administered neoadjuvant chemotherapy to 49.2% of patients who were treated during the post publication period. Results similar to the primary analysis were garnered when comparing the high and low users of this cohort while matching case volumes with the tendency to administer neoadjuvant chemotherapy.

Primary findings were not altered when covariates were omitted, and the results did not depend on model-based estimates of median survival time. Additionally, excluding patients who were treated in 2010 or 2011 to allow a ramp-up period or defining the cutoff year in 2008 or 2009 did not change the findings.

“This comparative effectiveness research study suggests that programs with high use of neoadjuvant chemotherapy after 2010 achieved greater improvements in short-term mortality and equivalent gains in median overall survival compared with programs that continued to use the treatment infrequently,” investigators concluded.

Reference

Melamed A, Rauh-Hain JA, Gockley AA, et al. Association between overall survival and the tendency for cancer programs to administer neoadjuvant chemotherapy for patients with advanced ovarian cancer. JAMA Oncol. Published Online September 30, 2021. doi:10.1001/jamaoncol.2021.4252