How Effective Is Chemotherapy Before Surgery For Ovarian Cancer? They Call it “Neoadjuvant”

“If we choose to use neoadjuvant chemotherapies for patients with newly diagnosed ovarian cancer, we would like to see clinical evidence that the cancer has regressed,” Dr. Alvarez says. “Something like the reduction of ascites (abdominal fluid), less evidence of cancer on physical exams or imaging studies, and a significant drop in the CA 125.”

A CA 125 is a protein in the blood, and by performing a CA 125 test doctors might be able to detect early signs of ovarian cancer. Additionally, if the neoadjuvant chemotherapy is successful, women’s overall health should improve as well. Responding well to neoadjuvant chemotherapy is typically a good sign that when women undergo a surgical procedure for the disease, the results will also be successful.

Chemotherapy Options For Ovarian Cancer

While neoadjuvant chemotherapy has proven to be a successful treatment option for many women, deciding which treatment is best is a decided case-by-case. There are several different types of drugs and different protocols that doctors can select among, choosing combinations, dosages, sequences and treatments they think will best work for their patients. However, carboplatin and paclitaxel are considered the gold standard of treatment in many cases, which are drugs given together every three weeks in cycles during treatment. However, like many chemotherapies, these drugs do come with their own side effects.

The main side effects of carboplatin and paclitaxel are that they can lower blood counts, which can make patients susceptible to bleeding and infections. To monitor this side effect, some patients may need a blood transfusion. Women may also experience nausea, vomiting, and fatigue but they are easily managed. Additionally, hair loss is often an inevitable side effect of chemotherapy, but for women who would like to keep some of their hair during treatment, cooling caps might be able to slow hair thinning.

Neoadjuvant chemotherapy may be paired with bevacizumab (brand name Avastin) a drug that is used for ovarian cancer. The drug is administered intravenously and can be given in combination with other chemotherapy drugs.  Avastin works by affecting the growth of blood vessels, starving tumors of the blood they need as nourishment. Avastin may also be used as a maintenance therapy for a year or so after surgery and was just approved by the FDA to be used in conjunction with olaparib (brand name LYNPARZA) in HRD (Homologous Recombination Deficiency) positive women who show a response to platinum-based chemotherapy.  The results of a recent trial showed an increase in progression-free survival from an average of 17 to 37 months in women with HRD and a BRCA mutation using this regimen. For women with HRD but no BRCA mutation the improvement was 16.6 to 28 months.

 

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