Efficacy of Neoadjuvant Chemotherapy as pre-habilitation program in advanced epithelial ovarian cancer

Approximately 70 % of ovarian cancer patients present at diagnosis with advanced disease(AOC) and impaired clinical conditions, making them not ideal surgical candidates. We aimed to investigate whether neoadjuvant chemotherapy(NACT) can modify pre-operative characteristics of patients at high risk(HR) of perioperative complications, as defined in the Mayo Clinic Algorithm. We also compared their morbidity and survival outcomes with comparable HR women undergoing primary surgery (PCS).

We retrospectively collected FIGO stage III and greater AOC patients undergoing either NACT-interval cytoreductive surgery(HR-NACT) or PCS from 01/2013 to 12/2022. HR features included: Albumin <3.5 g/dL or age≥80 years or age 75-79 and at least one among: ECOG PS > 1, stage IV disease, or complex surgery likely (more than hysterectomy, salpingo-oophorectomy and omentectomy).

400 patients were included. Among them, 298 met the criteria for the HR-NACT group; 203(68.1 %) underwent ICS after 3-4 cycles whislt 95(31.9 %) completed 6 NACT cycles. We reported an improvement in clinical variables in women undergoing 3-4 cycles of NACT: raise of ECOG = 0 rate(53.3 % vs 81.8 %; p < 0.001) and median albumin serum levels(3.0 g/dl vs 4.0 g/dl; p < 0.001). We identified 102 comparable HR-PCS patients. No difference in intraoperative complications was detected, while a difference was found in severe post-operative complications, favoring patients treated with both 3-4(5.4 % vs 18.6 % p = 0.0003) and 6 NACT cycles(7.8 % vs 18.6 %, p = 0.053). No difference in both DFS and OS was reported.

We offer a rationale to combine non interventional pre-habilitation procedure with short term chemotherapy cycles, aiming to improve pre-operative conditions of selected HR patients.