Neoadjuvant chemotherapy for advanced ovarian cancer: overview of outcomes and unanswered questions

Neoadjuvant chemotherapy for advanced ovarian cancer was initially administered as an alternative treatment for patients not suitable for primary debulking surgery (PDS) because of unresectable tumor or poor performance status. Accumulation of favorable outcomes of this treatment compared with standard treatment starting with PDS made this strategy a candidate for prospective, randomized Phase III studies without limiting the subjects to patients who were unsuitable for PDS. Among the four Phase III studies to date, the earliest study from the European Organization for Research and Treatment of Cancer (EORTC) has revealed noninferior survival with less-serious morbidity in the neoadjuvant chemotherapy arm. These data suggest that neoadjuvant chemotherapy followed by surgical cytoreduction is an acceptable management strategy for patients with advanced ovarian cancer. In this article, we review the treatment outcomes and discuss some unanswered questions, as well as possible future research in this area.