Alon Altman, MD, discusses a study that examined the effects of number of neoadjuvant chemotherapy cycles on patient outcomes.
In an interview withTargeted Oncology, Altman, associate professor and gynecologic oncologist at the University of Manitoba, discussed the objectives of the study, as well as the findings and next steps.
TARGETED ONCOLOGY:You’re presenting a national multicenter study that investigated cell cycle numbers in neoadjuvant chemotherapy. Can you give an overview of the study?
There are a couple big studies that showed equivalence of neoadjuvant chemotherapy to primary debulking, so across the world a lot of centers have shifted to more and more patients getting neoadjuvant chemotherapy, followed by surgery, and then further chemotherapy. But when you look at it retrospectively, multiple studies, including some from our center and a couple other centers in Canada that I know of, have shown that the outcomes for the neoadjuvant group was not quite as good.
We were trying to figure out why, so we had this multi-institutional study that included Calgary and Alberta, Winnipeg and Manitoba, Toronto and Ontario, and London and Ontario. We collected data on stage 3C and 4 high-grade ovarian cancers and then looked at their outcomes.
One subset of that was looking at the number of cycles in the neoadjuvant setting, because Calgary and Winnipeg standardly give 3 cycles of neoadjuvant before surgery and then 6 after, whereas Toronto and London have standardly given 3 and 3. We were wondering if that made any differences in outcome. That is where the study came from initially.
TARGETED ONCOLOGY:What were the findings of the study?
The problem with that is the number of patients we ended up having in each group. The 2 groups were equivalent, so there was no difference. Part of that is that there may not be a difference. Part of that might be that we had too few patients still.
We did actually find a difference in people who got 4 or more neoadjuvant cycles, they did significantly worse in their overall survival. I don’t think that’s necessarily because of the number of cycles they got. They’re probably sicker patients, older patients, patients who have more comorbidities, so the reasons for either putting off their surgery or having surgery later or something else that the clinician had to deal with, but their survival is worse.
TARGETED ONCOLOGY:What are the next steps in terms of finding the right number of cycles?
I think we’re going to have to revisit the data from the centers in our country that do that, probably in about 10 years, and have a look. A randomized trial would be great, but I don’t delude myself that that would be easy to do.
Within our site, we’re looking at all of our ovarian cancer patients and looking at cycle number and effects of neoadjuvant chemotherapy and trying to figure out who got neoadjuvant chemotherapy and why and what were the predictors of that. But again, that’s a single site, so I think time will tell. We will have to reanalyze.
TARGETED ONCOLOGY:What would you like the main takeaway to be from this study?
Speaking for our entire group, I think the bottom line was that primary debulking is still probably the way to go. I think everybody kind of agrees with that. If you are choosing neoadjuvant chemotherapy, I hope you have a good reason and you should probably try to minimize the cycles beforehand, get to the surgery, and get to more treatment afterwards. Whether you do 3 or 6 cycles afterwards, I think is still up in the air. Certainly, from where we looked at it, 6 was not more toxic, it didn’t have more morbidity, and for that data we’re coming out with a different paper that will address that.