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 .
Weekly vs. Every-3-Week Paclitaxel and Carboplatin for Ovarian Cancer.
BACKGROUND A dose-dense weekly schedule of paclitaxel ( result ing in a greater frequency of drug delivery ) plus carboplatin every 3 weeks or the addition of bevacizumab to paclitaxel and carboplatin administered every 3 weeks has shown efficacy in ovarian cancer . We proposed to determine whether dose-dense weekly paclitaxel and carboplatin would prolong progression-free survival as compared with paclitaxel and carboplatin administered every 3 weeks among patients receiving and those not receiving bevacizumab .  METHODS We prospect ively stratified patients according to whether they elected to receive bevacizumab  and then r and omly assigned them to receive either paclitaxel , administered intravenously at a dose of 175 mg per square meter of body-surface area every 3 weeks , plus carboplatin ( dose equivalent to an area under the curve [ AUC ] of 6 ) for six cycles or paclitaxel , administered weekly at a dose of 80 mg per square meter , plus carboplatin ( AUC , 6 ) for six cycles . The primary end point was progression-free survival . RESULTS A total of 692 patients were enrolled , 84 % of whom opted to receive bevacizumab .  In the intention-to-treat analysis , weekly paclitaxel was not associated with longer progression-free survival than paclitaxel administered every 3 weeks ( 14.7 months and 14.0 months , respectively ; hazard ratio for disease progression or death , 0.89 ; 95 % confidence interval [ CI ] , 0.74 to 1.06 ; P=0.18 ) . Among patients who did not receive bevacizumab  , weekly paclitaxel was associated with progression-free survival that was 3.9 months longer than that observed with paclitaxel administered every 3 weeks ( 14.2 vs. 10.3 months ; hazard ratio , 0.62 ; 95 % CI , 0.40 to 0.95 ; P=0.03 ) . However , among patients who received bevacizumab , weekly paclitaxel did not significantly prolong progression-free survival , as compared with paclitaxel administered every 3 weeks ( 14.9 months and 14.7 months , respectively ; hazard ratio , 0.99 ; 95 % CI , 0.83 to 1.20 ; P=0.60 ) . A test for interaction that assessed homogeneity of the treatment effect showed a significant difference between treatment with bevacizumab and without bevacizumab ( P=0.047 ) . Patients who received weekly paclitaxel had a higher rate of grade 3 or 4 anemia than did those who received paclitaxel every 3 weeks ( 36 % vs. 16 % ) , as well as a higher rate of grade 2 to 4 sensory neuropathy ( 26 % vs. 18 % ) ; however , they had a lower rate of grade 3 or 4 neutropenia ( 72 % vs. 83 % ) . CONCLUSIONS Overall , weekly paclitaxel , as compared with paclitaxel administered every 3 weeks , did not prolong progression-free survival  among patients with ovarian cancer . ( Funded by the National Cancer Institute and Genentech ; GOG-0262 Clinical Trials.gov number , NCT01167712 . )
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 .