What are the recommended dosages for neoadjuvant (pre-surgical) and adjuvant (post-surgical) therapy in a patient with advanced ovarian cancer?

From the Guidelines

For advanced ovarian cancer, the standard neoadjuvant chemotherapy regimen consists of carboplatin (AUC 5-6) and paclitaxel (175 mg/m² over 3 hours) given intravenously every 3 weeks for 3-4 cycles before surgery, as recommended by the most recent guidelines 1.

Neoadjuvant Chemotherapy

The goal of neoadjuvant chemotherapy is to reduce the tumor size and improve the chances of optimal cytoreduction during surgery.

• The recommended regimen is carboplatin (AUC 5-6) and paclitaxel (175 mg/m²) given every 3 weeks for 3-4 cycles 1.
• This approach has been shown to improve progression-free survival in advanced ovarian cancer patients.

Adjuvant Chemotherapy

Following surgery, the same regimen is continued for adjuvant therapy, typically completing a total of 6 cycles (including the neoadjuvant cycles).

• The adjuvant chemotherapy regimen is also carboplatin (AUC 5-6) and paclitaxel (175 mg/m²) given every 3 weeks for 3-4 cycles after surgery 1.
• Maintenance therapy with a PARP inhibitor such as olaparib, niraparib, or rucaparib may be recommended for patients with BRCA mutations or homologous recombination deficiency for 2-3 years after completion of chemotherapy 1.

Considerations

Dose adjustments may be necessary based on patient-specific factors like renal function, bone marrow reserve, and performance status.

• Bevacizumab (15 mg/kg every 3 weeks) may also be added to the regimen and continued as maintenance for up to 15 months in high-risk patients 1.
• The choice of treatment should be based on disease and clinical characteristics of the patient, and the treatment plan should be individualized to optimize outcomes.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Epithelial ovarian, fallopian tube, or primary peritoneal cancer in combination with paclitaxel, pegylated liposomal doxorubicin, or topotecan for platinum-resistant recurrent disease who received no more than 2 prior chemotherapy regimens. ( 1. 6) 10 mg/kg every 2 weeks with paclitaxel, pegylated liposomal doxorubicin, or topotecan given every week 15 mg/kg every 3 weeks with topotecan given every 3 weeks

The recommended dosages for neoadjuvant and adjuvant therapy in a patient with advanced ovarian cancer are not explicitly stated in the provided drug label for bevacizumab. However, for platinum-resistant recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer, the dosage is 10 mg/kg every 2 weeks with paclitaxel, pegylated liposomal doxorubicin, or topotecan given every week, or 15 mg/kg every 3 weeks with topotecan given every 3 weeks 2.

For carboplatin, the dosage for single agent therapy in patients with recurrent ovarian carcinoma is 360 mg/m2 IV on day 1 every 4 weeks. In combination therapy with cyclophosphamide for previously untreated patients, the dosage is 300 mg/m2 IV on day 1 every 4 weeks for 6 cycles 3.

Key points:

• Bevacizumab dosages for platinum-resistant recurrent disease

• 10 mg/kg every 2 weeks with paclitaxel, pegylated liposomal doxorubicin, or topotecan given every week
• 15 mg/kg every 3 weeks with topotecan given every 3 weeks

• Carboplatin dosages for single agent and combination therapy

• Single agent: 360 mg/m2 IV on day 1 every 4 weeks
• Combination with cyclophosphamide: 300 mg/m2 IV on day 1 every 4 weeks for 6 cycles

From the Research

Neoadjuvant and Adjuvant Therapy in Advanced Ovarian Cancer

The recommended dosages for neoadjuvant (pre-surgical) and adjuvant (post-surgical) therapy in patients with advanced ovarian cancer vary depending on the specific treatment regimen and patient population.

• The standard first-line combination therapy for ovarian cancer comprises 6 cycles of adjuvant or neoadjuvant carboplatin (AUC5-6) with paclitaxel (175 mg/m2) every 3 weeks (PC-3W) 4.
• Alternatively, a weekly scheduling of paclitaxel 80 mg/m2 and carboplatin AUC2, administered on days 1,8, and 15 in a 28-day cycle (PC-W), has been shown to be as active and better tolerated than the standard PC-3W regimen 4.
• In the neoadjuvant setting, three cycles of weekly carboplatin plus paclitaxel, and intermittent olaparib administration, have been investigated as a potential treatment option for patients with advanced ovarian cancer 5.
• Six cycles of neoadjuvant carboplatin and paclitaxel have also been shown to be safe and effective in patients with stage IIIC/IV disease who are unsuitable for optimal primary debulking surgery 6.

Dosage and Administration

• Carboplatin: AUC5-6 every 3 weeks, or AUC2 weekly for 3 weeks with 1 week off-treatment 4, 5.
• Paclitaxel: 175 mg/m2 every 3 weeks, or 80 mg/m2 weekly for 3 weeks with 1 week off-treatment 4, 5.
• Olaparib: intermittent administration in combination with weekly carboplatin and paclitaxel 5.
• Niraparib: maintenance treatment for up to 3 years, with or without bevacizumab 7.

Patient Selection and Response Evaluation

• Neoadjuvant chemotherapy followed by interval debulking surgery may be an alternative treatment strategy for patients with advanced ovarian cancer who are unsuitable for primary debulking surgery 8.
• Patient selection for neoadjuvant chemotherapy should be based on individual factors, such as extent of disease, performance status, and potential for optimal debulking surgery 8.
• Response to neoadjuvant chemotherapy can be evaluated using imaging studies and molecular biology techniques 8.