From the Guidelines
Neoadjuvant and adjuvant therapies are crucial in ovarian cancer management, with neoadjuvant therapy involving 3-4 cycles of platinum-based chemotherapy before surgery and adjuvant therapy consisting of 6 cycles of chemotherapy after surgery, aiming to eliminate microscopic disease and reduce recurrence risk. The choice between primary surgery followed by adjuvant therapy versus neoadjuvant therapy depends on disease extent, patient factors, and the likelihood of achieving optimal cytoreduction 1.
Key Considerations
- Neoadjuvant therapy is particularly beneficial for patients with advanced disease (stage III or IV), poor performance status, or tumors that appear difficult to optimally debulk initially 1.
- Adjuvant therapy is administered after primary surgical debulking and includes similar chemotherapy regimens, usually 6 cycles of carboplatin/paclitaxel 1.
- For certain high-grade ovarian cancers, particularly those with BRCA mutations or homologous recombination deficiency, maintenance therapy with PARP inhibitors like olaparib, niraparib, or rucaparib may follow chemotherapy to extend progression-free survival 1.
- The tumor primary chemosensitivity exhibits a major independent prognostic impact on the feasibility of complete interval debulking surgery after neoadjuvant chemotherapy, risk of subsequent platinum-resistant relapse, efficacy of subsequent maintenance therapies with bevacizumab or PARP inhibitors, progression-free survival, overall and long-term survival 1.
Treatment Approaches
- Primary debulking surgery (PDS) is the recommended approach for advanced-stage disease if the patient is a surgical candidate, optimal cytoreduction appears feasible, and fertility is not a concern 1.
- Neoadjuvant chemotherapy (NACT) with interval debulking surgery (IDS) should be considered for patients with advanced-stage ovarian cancer who are not good candidates for PDS due to advanced age, frailty, poor performance status, comorbidities, or disease that is unlikely to be optimally cytoreduced 1.
- Patients treated with NACT and IDS should also receive postoperative adjuvant chemotherapy 1.
From the FDA Drug Label
INDICATIONS Initial Treatment of Advanced Ovarian Carcinoma Carboplatin injection is indicated for the initial treatment of advanced ovarian carcinoma in established combination with other approved chemotherapeutic agents.
INDICATIONS & USAGE Paclitaxel Injection, USP is indicated as subsequent therapy for the treatment of advanced carcinoma of the ovary.
Neoadjuvant and Adjuvant Therapies in Ovarian Cancer:
- Neoadjuvant therapy refers to the treatment given before the main treatment, which in the case of ovarian cancer, is usually surgery. Although the provided drug labels do not directly mention neoadjuvant therapy, it is a common approach in ovarian cancer treatment, especially for advanced stages.
- Adjuvant therapy refers to the treatment given after the main treatment to reduce the risk of cancer recurrence. The label for paclitaxel 2 mentions its use in adjuvant treatment, but specifically for node-positive breast cancer, not ovarian cancer. However, paclitaxel is indicated for the treatment of advanced carcinoma of the ovary, which can include adjuvant settings, though it's not explicitly stated for ovarian cancer.
Given the information provided in the drug labels, there is no direct mention of neoadjuvant therapy in ovarian cancer, and the mention of adjuvant therapy is not specific to ovarian cancer. Therefore, the labels do not fully address the question regarding neoadjuvant and adjuvant therapies in ovarian cancer.
From the Research
Neoadjuvant and Adjuvant Therapies in Ovarian Cancer
- Neoadjuvant therapy refers to the treatment given before the main treatment, which in the case of ovarian cancer, is usually surgery 3, 4, 5, 6, 7.
- Adjuvant therapy, on the other hand, is the treatment given after the main treatment to lower the risk of the cancer coming back 3, 4, 5, 6, 7.
Neoadjuvant Chemotherapy
- Neoadjuvant chemotherapy (NAC) is a type of neoadjuvant therapy that uses chemotherapy to shrink the tumor before surgery 3, 4, 5, 6, 7.
- NAC has been shown to be effective in reducing the size of the tumor, making it easier to remove surgically, and improving the chances of a complete resection 5, 6, 7.
- Studies have also shown that NAC can reduce the risk of postoperative complications and improve overall survival rates 4, 6, 7.
Adjuvant Chemotherapy
- Adjuvant chemotherapy is a type of adjuvant therapy that uses chemotherapy to kill any remaining cancer cells after surgery 3, 4, 5, 6, 7.
- Adjuvant chemotherapy has been shown to improve overall survival rates and reduce the risk of recurrence in ovarian cancer patients 3, 4, 5, 6, 7.
- The choice of adjuvant chemotherapy regimen depends on various factors, including the stage and type of cancer, as well as the patient's overall health and performance status 3, 4, 5, 6, 7.
Comparison of Neoadjuvant and Adjuvant Therapies
- Studies have compared the effectiveness of neoadjuvant and adjuvant therapies in ovarian cancer patients, with some showing that neoadjuvant chemotherapy can be as effective as adjuvant chemotherapy in improving overall survival rates 6, 7.
- However, other studies have found that adjuvant chemotherapy can be more effective in reducing the risk of recurrence and improving overall survival rates 3, 4, 5.
- The choice between neoadjuvant and adjuvant therapies ultimately depends on various factors, including the patient's individual needs and preferences, as well as the specific characteristics of the cancer 3, 4, 5, 6, 7.