Neoadjuvant chemotherapy in advanced ovarian cancer: optimal patient selection and response evaluation

Epithelial ovarian cancer (EOC) is the leading cause of death from gynecologic malignancy and is the seventh most common cancer among women worldwide. The primary debulking surgery (PDS) followed by adjuvant chemotherapy (ACT) is a standard treatment of advanced EOC. However, there are still several limitations, such as high recurrence rate and subsequent chemoresistance. To date, many studies have reported that neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) shows non-inferior survival outcome and is associated with less postoperative morbidity compared with PDS. Therefore, NACT-IDS might be an alternative treatment strategy in advanced EOC. Nevertheless, the efficacy of NACT-IDS and selection of patients who would gain benefit from NACT-IDS are still on debate. To date, several studies have been conducted to predict the response of NACT using various methods, such as imaging studies and molecular biology techniques. In this article, the optimal indications for NACT using various methods will be discussed.