The published studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer , neoadjuvant chemotherapy and interval cytoreduction are non-inferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioperative morbidity and mortality .
PURPOSE To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer .
Long-term results of dose-dense paclitaxel and carboplatin versus conventional paclitaxel and carboplatin for treatment of advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer (JGOG 3016): a randomised, controlled, open-label trial.
BACKGROUND The primary analysis of the JGOG 3016 trial showed that a dose-dense paclitaxel and carboplatin regimen significantly improves progression-free and overall survival compared with the conventional regimen as first-line chemotherapy for patients with epithelial ovarian , fallopian tube , or primary peritoneal cancer . We report the long-term follow-up results for survival . METHODS This r and omised controlled trial was done at 85 centres in Japan . Patients with stage II-IV ovarian cancer were r and omly assigned to receive conventional treatment ( carboplatin area under the curve [ AUC ] 6 mg/mL per min and paclitaxel 180 mg/m(2 ) on day 1 ) or dose-dense treatment ( carboplatin AUC 6 mg/mL per min on day 1 and paclitaxel 80 mg/m(2 ) on days 1 , 8 , and 15 ) . The treatments were repeated every 3 weeks for six cycles ; responding patients had three additional cycles . The r and omisation was done central ly by telephone or fax , stratified by residual disease , stage , and histological type . The primary endpoint was progression-free survival ; overall survival was a secondary endpoint . Long-term information on adverse events was not collected . Efficacy analyses were by intention to treat . This study is registered with Clinical Trials.gov , number NCT00226915 . FINDINGS 637 patients were enrolled , of whom 631 were analysed ( 312 assigned to the dose-dense regimen , 319 to the conventional regimen ) . Median follow-up was 76·8 months ( IQR 68·9 - 85·6 ) . Median progression-free survival was significantly longer in the dose-dense treatment group than in the conventional treatment group ( 28·2 months [ 95 % CI 22·3 - 33·8 ] vs 17·5 months [ 15·7 - 21·7 ] ; hazard ratio [ HR ] 0·76 , 95 % CI 0·62 - 0·91 ; p=0·0037 ) . Median overall survival was 100·5 months ( 95 % CI 65·2-∞ ) in the dose-dense treatment group and 62·2 months ( 52·1 - 82·6 ) in the conventional treatment group ( HR 0·79 , 95 % CI 0·63 - 0·99 ; p=0·039 ) . INTERPRETATION Dose-dense treatment offers better survival  than conventional treatment and is a potential new st and ard of care for first-line chemotherapy for patients with advanced epithelial ovarian cancer
The published studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer , neoadjuvant chemotherapy and interval cytoreduction are non-inferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioperative morbidity and mortality .
PURPOSE To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer .