Dr. Duska on Neoadjuvant Chemo Vs Upfront Surgery in Ovarian Cancer

Linda R. Duska, MD, professor of obstetrics and gynecology, University of Virginia, discusses neoadjuvant chemotherapy versus upfront surgical debulking in patients with advanced ovarian cancer.

Many physicians believe that upfront surgical debulking is the best option for most patients with ovarian cancer; however, research is showing that there are subgroups of patients who benefit from neoadjuvant chemotherapy, explains Duska. Some studies suggest that neoadjuvant chemotherapy is equivalent to primary debulking surgery and may be less morbid, according to Duska.

Two studies examining neoadjuvant chemotherapy versus upfront surgical debulking enrolled women who were older, had bulkier disease, and poorer performance status. Duska says this is a different patient population than typical studies, and these studies have been criticized for low debulking rates. However, these data show that a certain subgroup of patients, such as those with stage IV disease, seem to benefit from neoadjuvant chemotherapy over primary debulking surgery, concludes Duska.