Ovarian cancer is the fifth leading cause of death from cancer in women worldwide—the majority of patients present at advanced stages of the disease, where survival rates remain low. In recent years, neoadjuvant chemotherapy has become the standard treatment for ovarian cancer. This article from Vinay K Malviya MD, discusses the role of neoadjuvant chemotherapy in ovarian cancer.
What Is Neoadjuvant Therapy?
Neoadjuvant chemotherapy refers to treatment given before surgery. It is often used in patients with stage III ovarian cancer who have high-risk factors (such as extra ovarian disease) or do not respond well to first-line therapy. In neoadjuvant chemotherapy, an initial course of drugs is administered to shrink tumors before they are surgically removed. Patients then receive additional rounds of chemotherapy after surgery.
This therapy allows the patient to receive optimal care before surgically removing the disease. This strategy is particularly effective in treating early-stage ovarian cancer because it provides information regarding tumor burden and response to therapy.
How Does it Work?
The purpose of neoadjuvant therapy (N) is to shrink tumors to make them easier to treat surgically. N-treatment works by shrinking tumor cells in different ways.
- One way is by killing cancerous cells directly.
- Another way is by making the immune system attack cancer cells.
In the past, surgical removal was the only treatment option for cancers. But now, doctors use N-therapy to shrink tumors before removing them. You may have heard about a surgery called mastectomy. That means they remove your breasts completely, even if only one breast is affected. But today, surgeons often perform less invasive procedures called a lumpectomy. It means they take out just the lumpy area of the breast. Lumpectomy is much safer than mastectomy because it does not remove the entire breast.
Advantages
The primary advantage of neoadjuvant chemotherapy is that it may reduce tumor size and allow for complete surgical removal of all visible tumors. When combined with optimal cytoreduction, this approach achieves long-term survival rates similar to those in women treated without preoperative chemotherapy. Below, Dr. Vinay has outlined four major benefits of this practice:
Here are the four ways how neoadjuvant therapy works to help a patient from Dr. Vinay:
-
Shrinking the Tumor Helps Remove Cancer Cells
Cancer begins in small groups of cells called microtumors. These smaller tumors start spreading throughout the body and become larger over time. As these tumors get bigger, they can cause damage to surrounding normal cells and organs. In addition, these tumors can block blood flow to the heart, lungs, kidneys, and liver, leading to organ failure.
Neoadjuvant therapy shrinks tumors before surgery. And shrinking the tumors makes the surgery easier to do. After the surgery, the surgeon removes any remaining tumor cells.
-
Making the Immune System Attack Cancer Cells Makes Them Harder to Spread
Neoadjuvant therapies help the immune system fight cancer cells. When the immune system attacks cancer cells, it creates antibodies to destroy them. Antibodies are proteins produced by white blood cells when exposed to foreign substances. So, when the immune system sees cancer cells, antibodies are created to kill them. Neoadjuvant treatments give the immune system a head start so that it can attack cancer cells faster.
-
Shrinkage Allows Better Surgical Removal
When a tumor grows larger, it takes up more space. It causes problems for other parts of the body. For example, if a tumor blocks blood flow in your arm, your hand could swell up and not work properly. Or, if the tumor blocks the flow of air in your chest cavity, breathing becomes difficult. So, a tumor removed while it’s still small may leave the patient with fewer complications.
-
Shrinkage Gives Surgeons More Time to Do Surgery
According to Vinay K Malviya, MD, if a tumor is big enough, it can interfere with how well a person breathes or how their organs function. Bigger tumors also increase the risk of bleeding during surgery. So, having a tumor shrink first gives surgeons more time to do the surgery safely.
Disadvantages
Neoadjuvant therapy is associated with adverse effects, including nausea, vomiting, diarrhea, fatigue, fever, weight loss, and pain at the injection site. These side effects may occur due to the use of chemotherapeutic agents.
-
Incomplete resection
Incomplete resection of tumor cells occurs in about 20% of neoadjuvant chemotherapy patients. It results in residual disease after surgery and an increased risk of recurrence.
-
Increased toxicity
The use of neoadjuvant therapy increases the toxicities of chemotherapy.
-
Reduced efficacy
Chemotherapy regimens that are effective in metastatic disease may not be effective in early-stage breast cancer.
-
Delay in diagnosis
Diagnosis delays occur in approximately 30% of patients who undergo neoadjuvant therapy.
-
Increased cost
Increased costs of treatment are incurred due to the use of neoadjuvant.
-
Decreased quality of life
Decreased quality of life is observed in patients treated with neoadjuvant therapy compared to those receiving adjuvant therapy alone.
Treatment Process
Patients should receive intravenous paclitaxel followed by carboplatin or cisplatin. After three cycles of chemotherapy, if the tumor shrinks significantly, the patient undergoes surgery. If the tumor does not shrink significantly, the patient receives four more cycles of the same type of chemotherapy, followed by surgery.
Outcomes
In a study published in 2010, women who received neoadjuvant chemotherapy had improved outcomes compared to those who did not. Women who received neoadjuvant tended to live longer than women who did not receive them. Survival was also increased for women whose tumors were reduced by more than 50% following neoadjuvant therapy.
Summary
In short, neoadjuvant chemotherapy may give patients with ovarian cancer a better chance of survival than standard treatments alone. However, this approach has some drawbacks, so consult with your doctor before deciding whether it’s right for you or not, suggests Vinay K Malviya, MD.
