Optimal timing of interval debulking surgery for advanced epithelial ovarian cancer: A retrospective study from the ESME national cohort

Thomas, Quentin Dominique; Boussere, Amal; Classe, Jean‐Marc; Pomel, Christophe; Costaz, Hélène; Rodrigues, Manuel; Ray‐Coquard, Isabelle; Gladieff, Laurence; Rouzier, Roman; Rouge, Thibault De La Motte; Gouy, Sébastien; Barranger, Emmanuel; Sabatier, Renaud; Floquet, Anne; Marchal, Frédéric; Guillemet, Cécile; Polivka, Valentine; Martin, Anne‐Laure; Colombo, Pierre‐Emmanuel; Fiteni, Frédéric

doi:10.1016/j.ygyno.2022.08.005

Cited by 9 publications

(13 citation statements)

References 41 publications

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“…The primary objective of 15 studies was the investigation of PFS and OS with respect to the number of NACT cycles [ 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 ], while in the remaining studies this result was reported but not as the primary outcome [ 28 29 30 31 32 33 ].…”

Section: Resultsmentioning

confidence: 99%

“…Regarding survival outcomes, 16 studies [ 13 16 17 18 19 21 22 23 26 27 28 29 30 32 33 35 ] showed no significant differences in PFS and OS when comparing patients undergoing delayed or early IDS. In 6 studies [ 14 15 20 24 25 31 ], an unfavorable outcome was linked to an increase in the number of NACT cycles prior to IDS. Interestingly, Stoeckle et al [ 30 ] discovered a trend towards improved survival in patients undergoing delayed IDS (≥5 cycles of NACT), although the results were not statistically significant.…”

Section: Resultsmentioning

confidence: 99%

“…Out of the 22 studies, 15 [ 13 14 16 17 18 19 20 21 24 26 28 29 30 33 35 ] established 4 cycles as the threshold for “early” IDS and compared surgery after < 4 cycles to surgery > 5 or more cycles of NACT. The other 7 studies [ 15 22 23 25 27 31 32 ] established 3 cycles as the threshold for “early” IDS and compared surgery after ≤3 NACT cycles with surgery after ≥4 NACT cycles.…”

Section: Resultsmentioning

confidence: 99%

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Optimal number of neoadjuvant chemotherapy cycles prior to interval debulking surgery in advanced epithelial ovarian cancer: a systematic review and meta-analysis of progression-free survival and overall survival

Coada,

Dondi,

Ravegnini

et al. 2023

J Gynecol Oncol

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Objective Neoadjuvant chemotherapy (NACT) represents a treatment option in patients with advanced epithelial ovarian cancer (AEOC) who are not good candidates for primary debulking surgery. Usually, 3 cycles of chemotherapy before surgery have been considered the best option for patient survival, although quite often some patients receive more than 3 cycles. The aim of this systematic review and meta-analysis was to identify the optimal number of NACT cycles reporting better survival in AEOC patients. Methods PubMed, Cochrane Library, and Scopus were searched for original articles that analyzed the relationship between the number of chemotherapy cycles and clinical outcomes in AEOC patients before interval debulking surgery (IDS). The main outcomes were progression-free survival (PFS) and overall survival (OS). Results A total of 22 studies comprising 7,005 patients diagnosed with AEOC were included in our analysis. In terms of survival, the reviewed studies dividing the patients in ≤3 NACT cycles vs. >3, showed a trend for a decrease in PFS and a significant reduction in OS with an increasing number of cycles, while a difference in both PFS and OS was revealed if early IDS included patients with 4 NACT cycles. These results should be interpreted with caution due to the complex characteristics of AEOC patients. Conclusion In conclusion, our review and meta-analysis revealed that there is not enough evidence to determine the optimal number of NACT treatments before surgery. Further research in the form of well-designed randomized controlled trials is necessary to address this issue. Trial Registration PROSPERO Identifier: CRD42022334959

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Optimal number of neoadjuvant chemotherapy cycles prior to interval debulking surgery in advanced epithelial ovarian cancer: a systematic review and meta-analysis of progression-free survival and overall survival

Coada,

Dondi,

Ravegnini

et al. 2023

J Gynecol Oncol

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“…As a way to assess the optimal timing of ICS, we recently performed a retrospective study attempting to limit the bias of confounding factors influencing the selection of patients for a standard ICS (i.e., 3-4 NACT cycles) or delayed ICS (i.e., ≥5 NACT cycles) using two propensity score statistical methods (the inverse probability of treatment weights, or IPTW method, and the propensity score matching method) on a large French national cohort (the epidemiological strategy and medical economics, or ESME) of 928 aEOC patients [59]. The ESME research program is based on data collected from expert French Comprehensive Cancer Centers, with the aim of providing independent and high-quality RWD collected from electronic health records.…”

Section: Apart From Primary Versus Interval Surgeries: How Many Nact ...mentioning

confidence: 99%

Optimal First-Line Medico-Surgical Strategy in Ovarian Cancers: Are We There Yet?

Quesada

Thomas

Colombo

et al. 2023

Cancers

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In spite of tremendous advances in advanced ovarian cancer management through the past decade, notably owing to surgical expertise and novel combination molecules (including bevacizumab and PARP inhibitors), the optimal initial sequential strategy remains a major concern. Indeed, following seminal clinical trials, primary cytoreductive surgery (PCS) followed by adjuvant systemic therapy and interval cytoreductive surgery (ICS) following neoadjuvant chemotherapy (NACT) have been positioned as validated alternatives with distinct pros and cons, although a definite response is still unassessed. In clinical practice, decisions between PCS and ICS rely on multilayer parameters: the tumor itself, the patient, and the health structure. In this state-of-the-art review, we will discuss the current evidence based on clinical trials and real-world data and highlight the remaining questions, including the fittest positioning of PCS vs. ICS and the optimal number of NACT cycles; subsequently, we will discuss current axes of research such as dedicated clinical trials and more global perspectives. These ongoing strategies and perspectives could contribute to improving the patient journey through personalized medicine.

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“…It offers a large real-world multicenter cohort, with demographics, tumor characteristics, clinical features, clinical events, and treatment-related data that may lead to a better knowledge of ovarian cancer disease history. Based on the ESME ovarian cancer platform, two studies that assessed the specificities of endometrioid ovarian cancers and the optimal timing of debulking surgery have been published recently [ 31 , 32 ].…”

Section: Introductionmentioning

confidence: 99%

Real-World Data on Newly Diagnosed BRCA-Mutated High-Grade Epithelial Ovarian Cancers: The French National Multicenter ESME Database

Bini

Quesada

Méeus

et al. 2022

Cancers

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Background: In spite of the frequency and clinical impact of BRCA1/2 alterations in high-grade epithelial ovarian cancer (HGEOC), real-world information based on robust data warehouse has been scarce to date. Methods: Consecutive patients with BRCA-mutated HGEOC treated between 2011 and 2016 within French comprehensive cancer centers from the Unicancer network were extracted from the ESME database. The main objective of the study was the assessment of clinicopathological and treatments parameters. Results: Out of the 8021 patients included in the ESME database, 266 patients matching the selection criteria were included. BRCA1 mutation was found in 191 (71.8%) patients, while 75 (28.2%) had a BRCA2 mutation only; 95.5% of patients received a cytoreductive surgery. All patients received a taxane/platinum-based chemotherapy (median = six cycles). Complete and partial response were obtained in 53.3% and 20.4% of the cases, respectively. Maintenance therapy was administered in 55.3% of the cases, bevacizumab being the most common agent. After a median follow up of 51.7 months, a median progression-free survival of 28.6 months (95% confidence interval (CI) [26.5; 32.7]) and an estimated 5-year median overall survival of 69.2% (95% CI [61.6; 70.3]) were reported. Notably, BRCA1- and BRCA2-mutated cases exhibited a trend towards different median progression-free survivals, with 28.0 (95% CI [24.4; 32.3]) and 33.3 months (95% CI [26.7; 46.1]), respectively (p-value = 0.053). Furthermore, five-year OS for BRCA1-mutated patients was 64.5% (95% CI [59.7; 69.2]), while it was 82.5% (95% CI [76.6; 88.5]) for BRCA2-mutated ones (p-value = 0.029). Conclusions: This study reports the largest French multicenter cohort of BRCA-mutated HGEOCs based on robust data from the ESME, exhibiting relevant real-world data regarding this specific population.

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Optimal timing of interval debulking surgery for advanced epithelial ovarian cancer: A retrospective study from the ESME national cohort

Cited by 9 publications

References 41 publications

Optimal number of neoadjuvant chemotherapy cycles prior to interval debulking surgery in advanced epithelial ovarian cancer: a systematic review and meta-analysis of progression-free survival and overall survival

Optimal number of neoadjuvant chemotherapy cycles prior to interval debulking surgery in advanced epithelial ovarian cancer: a systematic review and meta-analysis of progression-free survival and overall survival

Optimal First-Line Medico-Surgical Strategy in Ovarian Cancers: Are We There Yet?

Real-World Data on Newly Diagnosed BRCA-Mutated High-Grade Epithelial Ovarian Cancers: The French National Multicenter ESME Database

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