Debulking Surgery and Intraperitoneal Chemotherapy Are Associated With Decreased Morbidity in Women Receiving Neoadjuvant Chemotherapy for Ovarian Cancer

Robinson, William R.; Cantillo, Evelyn

doi:10.1097/igc.0000000000000009

Cited by 3 publications

(4 citation statements)

References 12 publications

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“…Then, 45 studies were excluded that had no survival condition associated with NAC or PDS, no comparison between NAC followed by IDS and PDS followed by chemotherapy, no full text, or in which the optimal cytoreduction was not defined as residual disease ≤1 cm [9-12]. Subsequently, 11 studies were excluded in which the FIGO stages were III and IV [3, 13-20] or chemotherapies were administered intraperitoneally [21, 22]. Eventually, 12 studies were included in this meta-analysis, comprising 1 RCT [4], 9 cohort studies [1, 11, 23-29], and 2 case-control studies [5, 30].…”

Section: Resultsmentioning

confidence: 99%

“…Originally, NAC followed by an IDS was limited to patients who were poor surgical candidates or unlikely to be resected optimally [7, 9-12, 14-22, 25-29, 31-40]. However, the EORTC/NCIC trial showed the similar median OS (30.0 vs. 29.0 months) and median PFS (12 vs. 12 months) between the NAC group and PDS group, concluding that NAC followed by IDS was a reasonable treatment for advanced ovarian carcinoma.…”

Section: Discussionmentioning

confidence: 99%

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Platinum-Based Neoadjuvant Chemotherapy versus Primary Surgery in Ovarian Carcinoma International Federation of Gynecology and Obstetrics Stages IIIc and IV: A Systematic Review and Meta-Analysis

Yunyun

Xie

Wang

et al. 2017

Gynecol Obstet Invest

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Background/Aim: This study aimed to compare neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS) with primary debulking surgery (PDS) followed by chemotherapy in patients with advanced ovarian carcinoma International Federation of Gynecology and Obstetrics (FIGO) stages IIIc and IV. Methods: PubMed, the Cochrane Library, and manual searches were applied to discriminate potentially eligible studies published before June 30, 2016. Results: A total of 12 comparative studies were finally included; 1,372 patients underwent NAC followed by IDS, and 2,680 patients underwent PDS followed by chemotherapy. For overall pooled estimates, significant between-trial differences were found in the optimal debulking rate, grade 3–5 postoperative adverse reactions, and median overall survival (OS), but no difference was found in the median progression-free survival (PFS). Moreover, a significantly higher incidence was identified in major infections, vascular events, and wound complications for patients in the PDS group. Conclusions: This study suggested that NAC followed by IDS could improve the optimal debulking rate and decrease the postoperative adverse reactions for the current studies, but whether it could improve the OS and PFS compared with PDS followed by chemotherapy in patients with ovarian carcinoma FIGO stages IIIc and IV were still needed to be verified by conducting more randomized controlled trials.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Platinum-Based Neoadjuvant Chemotherapy versus Primary Surgery in Ovarian Carcinoma International Federation of Gynecology and Obstetrics Stages IIIc and IV: A Systematic Review and Meta-Analysis

Yunyun

Xie

Wang

et al. 2017

Gynecol Obstet Invest

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“…This is concerning as 20% of patients required ICU admission after primary debulking surgery in a retrospective data review at a cancer center in the United States. 27 A large number of gynecological oncologists reported large-volume confluent peritoneal disease and confluent diaphragmatic disease as factors precluding optimal debulking (80% and 70%, respectively). Wimberger et al 28 reported that centers where procedures, such as peritoneal stripping, were regularly performed achieved higher rates of debulking to no visible disease when compared with centers that have not proven capability of performing such procedures.…”

Section: Discussionmentioning

confidence: 99%

Current South African clinical Practice in Debulking Surgery for Ovarian Cancer

Billson

Merwe²,

Soeters³

2016

Int J Gynecol Cancer

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“…IP paclitaxel administered in combination with IV (IV/IP) chemotherapy with or without IP platinum has been reported as a viable treatment approach for ovarian and peritoneal carcinomas. IP paclitaxel treatment has been used as a neoadjuvant [11], intra-operatively and hyperthermically [12], as an instillation after primary optimal cytoreductive surgery [13, 14], and after neoadjuvant chemotherapy or primary surgery with optimal debulking [15]. Several of these IP paclitaxel treatment methods resulted in 5-year survival rates >60 % [11, 13, 14].…”

Section: Introductionmentioning

confidence: 99%

A phase I study of intraperitoneal nanoparticulate paclitaxel (Nanotax®) in patients with peritoneal malignancies

Williamson

Johnson

Maulhardt

et al. 2015

Cancer Chemother Pharmacol

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Purpose This multicenter, open-label, dose-escalating, phase I study evaluated the safety, tolerability, pharmacokinetics and preliminary tumor response of a nanoparticulate formulation of paclitaxel (Nanotax®) administered intraperitoneally for multiple treatment cycles in patients with solid tumors predominantly confined to the peritoneal cavity for whom no other curative systemic therapy treatment options were available. Methods Twenty-one patients with peritoneal malignancies received Nanotax® in a modified dose-escalation approach utilizing an accelerated titration method. All patients enrolled had previously received chemotherapeutics and undergone surgical procedures, including 33 % with optimal debulking. Six doses (50–275 mg/m2) of Cremophor-free Nanotax® were administered intraperitoneally for one to six cycles (every 28 days). Results Intraperitoneal (IP) administration of Nanotax® did not lead to increases in toxicity over that typically associated with intravenous (IV) paclitaxel. No patient reported ≥Grade 2 neutropenia and/or ≥Grade 3 neurologic toxicities. Grade 3 thrombocytopenia unlikely related to study medication occurred in one patient. The peritoneal concentration–time profile of paclitaxel rose during the 2 days after dosing to peritoneal fluid concentrations 450–2900 times greater than peak plasma drug concentrations and remained elevated through the entire dose cycle. Best response assessments were made in 16/21 patients: Four patients were assessed as stable or had no response and twelve patients had increasing disease. Five of 21 patients with advanced cancers survived longer than 400 days after initiation of Nanotax® IP treatment. Conclusions Compared to IV paclitaxel administration, Cremophor-free IP administration of Nanotax® provides higher and prolonged peritoneal paclitaxel levels with minimal systemic exposure and reduced toxicity.

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Debulking Surgery and Intraperitoneal Chemotherapy Are Associated With Decreased Morbidity in Women Receiving Neoadjuvant Chemotherapy for Ovarian Cancer

Cited by 3 publications

References 12 publications

Platinum-Based Neoadjuvant Chemotherapy versus Primary Surgery in Ovarian Carcinoma International Federation of Gynecology and Obstetrics Stages IIIc and IV: A Systematic Review and Meta-Analysis

Platinum-Based Neoadjuvant Chemotherapy versus Primary Surgery in Ovarian Carcinoma International Federation of Gynecology and Obstetrics Stages IIIc and IV: A Systematic Review and Meta-Analysis

Current South African clinical Practice in Debulking Surgery for Ovarian Cancer

A phase I study of intraperitoneal nanoparticulate paclitaxel (Nanotax®) in patients with peritoneal malignancies

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