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Delays from neoadjuvant chemotherapy to interval debulking surgery and survival in ovarian cancer
  1. Ying L Liu1,
  2. Qin C Zhou2,
  3. Alexia Iasonos2,
  4. Olga T Filippova3,
  5. Dennis S Chi3,
  6. Oliver Zivanovic3,
  7. Yukio Sonoda3,
  8. Ginger Gardner3,
  9. Vance Broach3,
  10. Roisin OCearbhaill1,
  11. Jason A Konner1,
  12. Carol A Aghajanian1,
  13. Kara Long3 and
  14. William Tew1
  1. 1 Gynecologic Medical Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
  2. 2 Epidemiology-Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
  3. 3 Gynecologic Oncology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
  1. Correspondence to Dr William Tew, Gynecologic Medical Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; teww{at}mskcc.org

Abstract

Introduction Delays from primary surgery to chemotherapy are associated with worse survival in ovarian cancer, however the impact of delays from neoadjuvant chemotherapy to interval debulking surgery is unknown. We sought to evaluate the association of delays from neoadjuvant chemotherapy to interval debulking with survival.

Methods Patients with a diagnosis of stage III/IV ovarian cancer receiving neoadjuvant chemotherapy from July 2015 to December 2017 were included in our analysis. Delays from neoadjuvant chemotherapy to interval debulking were defined as time from last preoperative carboplatin to interval debulking >6 weeks. Fisher’s exact/Wilcoxon rank sum tests were used to compare clinical characteristics. The Kaplan–Meier method, log-rank test, and multivariate Cox Proportional-Hazards models were used to estimate progression-free and overall survival and examine differences by delay groups, adjusting for covariates.

Results Of the 224 women, 159 (71%) underwent interval debulking and 34 (21%) of these experienced delays from neoadjuvant chemotherapy to interval debulking. These women were older (median 68 vs 65 years, P=0.05) and received more preoperative chemotherapy cycles (median 6 vs 4, P=0.003). Delays from neoadjuvant chemotherapy to interval debulking were associated with worse overall survival (HR 2.4 95% CI 1.2 to 4.8, P=0.01), however survival was not significantly shortened after adjusting for age, stage, and complete gross resection, HR 1.66 95% CI 0.8 to 3.4, P=0.17. Delays from neoadjuvant chemotherapy to interval debulking were not associated with worse progression-free survival (HR 1.55 95% CI 0.97 to 2.5, P=0.062). Increase in number of preoperative cycles (P=0.005) and lack of complete gross resection (P<0.001) were the only variables predictive of worse progression-free survival.

Discussion Delays from neoadjuvant chemotherapy to interval debulking were not associated with worse overall survival after adjustment for age, stage, and complete gross resection.

  • ovarian cancer
  • medical oncology
  • surgical oncology
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Footnotes

  • Twitter @VanceBroach

  • Contributors All of the authors have made substantial contributions to the conception or design of the work or the acquisition, analysis, or interpretation of data; have participated in drafting the work or revising it critically for important intellectual content; have given final approval of the version to be published; and agree to be accountable for all aspects of the work, ensuring that any questions related to the accuracy or integrity of the work are appropriately investigated and resolved.

  • Funding This study was funded in part through the NIH/NCI Support Grant P30 CA008748.

  • Competing interests Dr. Iasonos reports personal fees from Mylan, outside the submitted work. Dr. Chi reports personal fees from Bovie Medical Co. (medical advisory board and stock options), Verthermia Inc. (medical advisory board and stock options), C Surgeries (shareholder), and Intuitive Surgical Inc (stock ownership), outside the submitted work. Dr. O'Cearbhaill reports personal fees from Clovis (medical advisory board) and Tesaro (medical advisory board), outside the submitted work. Dr. Konner reports personal fees from Clovis (guest speaker), AstraZeneca (medical advisory board), and Immunogen (medical advisory board), outside the submitted work. Dr. Aghajanian reports personal fees from Tesaro (medical advisory board), Immunogen (medical advisory board), Mateon Therapeutics (steering committee), and Cerulean Pharma (medical advisory board), grants and personal fees from Clovis (medical advisory board) and Genentech (steering committee), and grants from AbbVie (steering committee) and Astra Zeneca, outside the submitted work. Dr. Long Roche reports personal fees from Intuitive Surgical (travel), outside the submitted work.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Data available upon reasonable request from corresponding author:William P. Tew, MD: teww@mskcc.org.

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