Current practice for the treatment of ovarian cancer involves primary de-bulking surgery followed by chemotherapy. Neoadjuvant chemotherapy, or the delivery of chemotherapy before surgery, tends to be used in patients who are not candidates for upfront de-bulking surgery, observes James Tate Thigpen, MD, and Robert A. Burger, MD.

Warner K. Huh, MD, notes that reliable preoperative markers that predict which individuals will have successful de-bulking are not available, and candidates for surgery are still largely based on comorbidities and performance status. If patients meet a certain threshold, they may be better served with neoadjuvant chemotherapy.

In clinical trials, the ability to de-bulk to no gross residual was greater in the neoadjuvant chemotherapy group. However, this cohort did not show a survival advantage. Moreover, de-bulking rates for primary de-bulking surgery ranged from 30% to 83%. Thigpen comments that the variable frequency in which patients achieve optimal de-bulking and the unclear data surrounding neoadjvaunt chemotherapy leaves him not yet comfortable simply choosing one approach over another.