Dr. Wenham on Neoadjuvant Chemotherapy Versus Primary Debulking Surgery in Ovarian Cancer

Robert M. Wenham, MD, gynecologic oncologist and chair of the Department of Gynecologic Oncology at Moffitt Cancer Center, sheds light on the debate between neoadjuvant chemotherapy and primary debulking surgery in patients with newly diagnosed, advanced ovarian cancer.

Surgery is recommended for patients who present with advanced disease, says Wenham. Historically, up-front primary debulking surgery was the standard of care. However, 4 randomized trials have shown that neoadjuvant chemotherapy followed by interval debulking surgery is a reasonable alternative to primary debulking surgery.

These data may be biased in that the patients who are the best candidates for neoadjuvant chemotherapy are similar to the ones who enrolled on the trials, says Wenham. Approximately one-quarter of those patients had bulky stage IV disease and poor performance status. In terms of patient selection for primary debulking surgery, data have shown that patients with less disease and a better performance status might have better outcomes, adds Wenham.

In the ongoing TRUST trial, patients were randomized to primary debulking surgery followed by chemotherapy or neoadjuvant chemotherapy followed by interval debulking surgery. Notably, bevacizumab (Avastin) was incorporated into both arms of the trial. The trial is expected to complete in 2023 and may shed light on the optimal timing of debulking surgery in ovarian cancer, concludes Wenham.