Neoadjuvant chemotherapy (NACT) may decrease short-term mortality in patients with advanced ovarian cancer, according to research published in JAMA Oncology.

The researchers noted that randomized trials have shown similar long-term survival between patients who receive NACT and those who undergo primary surgery, but patients who receive NACT have demonstrated better perioperative outcomes.

For the current study, researchers evaluated data from the National Cancer Database to determine whether an increased use of NACT in recent years has affected clinical outcomes among patients with advanced ovarian cancer.

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The researchers compared patients treated in programs with a high use of NACT in the period following publication of relevant clinical trials (2010-2015) and patients treated in programs that maintained a low use of NACT during the same period. Programs were matched based on level of NACT use in the post-publication period, case volume, and use of NACT in the pre-publication period (2004-2009).

There were 19,562 patients treated in 332 programs that increased the use of NACT from 21.7% in 2004-2009 to 42.2% in 2010-2015. Another 19,737 patients were treated in 332 programs that only marginally increased the use of NACT between the same 2 periods, from 20.1% to 22.5%.

Programs with high and low use of NACT saw similar improvements in median overall survival (OS) over time. The median OS improved from 31.6 months to 37.9 months in the high-use programs (6.3-month difference) and improved from 31.4 months to 36.8 months in low-use programs (5.4-month difference).

However, the decrease in 1-year mortality rates was greater in high-use programs than in low-use programs. The 1-year mortality rate decreased from 25.6% to 19.3% in high-use programs (risk difference, -5.2%) and from 24.9% to 21.8% in low-use programs (risk difference, -3.2%).

“These results may reassure those concerned that frequent administration of neoadjuvant chemotherapy has harmed patients with advanced ovarian cancer,” the researchers wrote.

Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. 


Melamed A, Rauh-Hain JA, Gockley AA, et al. Association between overall survival and the tendency for cancer programs to administer neoadjuvant chemotherapy for patients with advanced ovarian cancer. JAMA Oncol. Published online September 30, 2021. doi:10.1001/jamaoncol.2021.4252