Mitchel Hoffman, MD, gynecologic oncologist, Moffitt Cancer Center, discusses ongoing research regarding neoadjuvant chemotherapy and primary debulking surgery in advanced ovarian cancer.

Historically, primary debulking surgery has been the standard up-front therapy in patients with advanced ovarian cancer, says Hoffman. However, recent trials and guidelines state that neoadjuvant therapy is within the standard of care.

Data from randomized phase III trials have not provided definitive evidence that one approach is better than another, says Hoffman. Rather, these trials have called attention to the importance of patient selection. The TRUST trial (NCT02828618) is evaluating the caliber of primary debulking surgery as well as its relative benefit versus neoadjuvant chemotherapy. Strict criteria will be put in place to control for confounding variables. However, it remains to be seen whether the results will point to a new standard of care, concludes Hoffman.

Videos

Dr. Hoffman on Research Regarding Neoadjuvant Chemo and Primary Debulking in Ovarian Cancer

Mitchel Hoffman, MD, gynecologic oncologist, Moffitt Cancer Center, discusses eligibility criteria for primary debulking surgery versus neoadjuvant chemotherapy in advanced ovarian cancer.

Some patients are clearly not fit for surgery, says Hoffman—for example, those with cancer that extends through the belly cavity. Moreover, patients whose intestinal function starts to decline are not fit for surgery. Furthermore, some patients have deep vein thrombosis, pulmonary embolism, or a variety of other symptoms that would prohibit them from undergoing surgery. Some patients are selected for surgery by doing CT scans and biopsies, adds Hoffman. Others may undergo laparoscopic surgery to determine whether surgery is recommended.

Conversely, if the CT scan shows extensive liver metastases, neoadjuvant chemotherapy is given. Others with a high burden of disease may only receive chemotherapy. Additionally, there are patients, who after receiving 3 cycles of chemotherapy, are evaluated to determine whether debulking is recommended, concludes Hoffman.

Mitchel Hoffman, MD

Articles

Dr. Hoffman on Research Regarding Neoadjuvant Chemo and Primary Debulking in Ovarian Cancer

Dr. Hoffman on Primary Debulking Versus Neoadjuvant Chemotherapy in Ovarian Cancer