pico pds vs nact

8/17/2019 Pico Pds vs Nact

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Dr. Rafyandi

PICO


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To determine the overall survival and relativeeect o multiple prognostic variables incohorts o patients ith advanced!stageovarian cancer treated ith platinum!based

neoad"uvant chemotherapy in lieu o primarycytoreductive surgery.


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Tenty!to cohorts o patients ith #tage IIIand I$ ovarian cancer %&'( patients) ereidentifed rom articles in *+D,I-+ %/&/0122()


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The mean number o patients in each cohortas '& %median3'14 range3205()

*edian survival time ranged rom 2.1 to 61.2months.

7or all cohorts ta8en together4 the meaneighted median survival time as 16.(months.


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+ach 29 increase inthe proportion opatients in each cohortundergoing ma:imalinterval cytoreductivesurgery as associatedith a ./ monthincrease in median

survival time%/(9CI32.1' months0'.(2 months4 p32.215).


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+ach incrementalchemotherapy cycleas signifcantlyassociated ith a 6.

month decrease inmedian survival time%/(9CI3&. to ;2.months4 p32.26


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+ach 29 increase inthe proportion opatients receiving ata:ane as associatedith a .< monthincrease in mediansurvival time %/(9CI32.&5 months01.1(

months4 p=2.222()


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+ach 29 increase in the proportion opatients ith stage I$ disease as associatedith an estimated 1.' month decrease inmedian survival time %/(9CI3;'.52 months

to ;.22 months4 p32.221).-o statistically signifcant relationship

beteen median cohort age and mediansurvival time %p32.66&).


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-eoad"uvant chemotherapy in lieu o primarycytoreduction is associated ith inerioroverall survival compared to initial surgery.

Increasing percent ma:imal cytoreduction ispositively associated ith median cohortsurvival


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The negative survival eect o increasingnumber o chemotherapy cycles prior tointerval surgery suggests that defnitiveoperative intervention should be underta8en

as early in the treatment program as possible.


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To compare

$#

Primarydebul8ing

surgery %PD#)olloed by

platinum!basedchemotherapy

-eoad"uvantchemotherapy%->CT) olloed

by intervaldebul8ing

surgery andadditional

chemotherapyin advanced ovarian

carcinoma.


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• Patients

+ligible patients had biopsy!proven stage IIICor I$ invasive epithelial ovarian carcinoma4primary peritoneal carcinoma4 or allopian!tubecarcinoma.

• Study design

Patients ere randomly assigned either to PD#

olloed by at least si: courses o platinum!based chemotherapy or to three courses o->CT olloed by interval debul8ing surgery


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5& patients ere enrolled

''< ?ere assigned to PD#''6 ?ere assignd to

->CT


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The overall test or a treatment eect on globalhealth as not signifcant.


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Overall survival as similar in the to groups in theintention!to!treat analyses %1/ months in the primary!surgery group and '2 months in the neoad"uvant!

chemotherapy group)


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Progression-free survival was similar in the two groups in the

intention-to-treat analyses (12 months in both groups)


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• Aa@ard ratio or death in the group assignedto neoad"uvant chemotherapy olloed byinterval debul8ing4 as compared ith thegroup assigned to primary debul8ing4 as

2./& %/29 confdence interval BCI4 2.&6 to.' P 3 2.2 or nonineriority)

• Aa@ard ratio or progressive disease as .2%/29 CI4 2.&/ to .().


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Similar results for overall survival (hazard ratio for death, 1!!"

#!$ %&, !' to 11" P * !!1 for noninferiority)


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PDS(months)

NACT(months)

-o residual tumor %optimal result) 6( '&

Residual tumors that measured to2 mm in diameter %suboptimalresult)

'1 15

Residual tumors larger than 2 mm%other result)

1< 1(


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The strongest independent predictors o prolongedsurvival4 in descending orderE

• >bsence o residual tumor ater surgery %P=2.22)

• #tage IIIC disease %P 3 2.22)

• #mall tumor si@e beore randomi@ation %P 3 2.22)

• +ndometrioid histologic type4 olloed indescending order by serous4 mi:ed4undierentiated4 mucinous4 and clear!cell types %P

3 2.22()• Founger age %P 3 2.22().


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The standard o care or omen ith stage IIIGor earlier!stage epithelial ovarian cancer H agroup ith a better prognosis than the currentstudy population H remains primary

cytoreductive surgery.Only those patients ith proven stage IIIC or

I$ disease should be considered orneoad"uvant chemotherapy.


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The clinician may assess important predictiveactors ith respect to residual macroscopicdisease ater debul8ing surgery %e.g.4presence or absence o coe:isting illnesses4

age4 disease burden4 location o metastaticsites4 ?AO perormance status4 and tumorstage).

,aparoscopy4 in addition to a:ial CT4 may

provide inormation about the disease burden


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->CT is not inerior to PD# or patients ithstage IIIC or I$ ovarian carcinoma.

-o signifcant advantages o ->CT or PD#ere observed ith respect to survival4

adverse eects4 uality o lie4 orpostoperative morbidity or mortality.


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To evaluate the use o neoad"uvantchemotherapy %->CT) and primary debul8ingsurgery %PD#) beore and ater results rom arandomi@ed trial ere published and shoed

nonineriority beteen ->CT and PD# in themanagement o advanced!stage ovariancarcinoma.


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#tudy design E retrospective analysisPlace E at *emorial #loan Jettering Cancer

Center

Time E Kanuary 4 122& to *ay 4 12'

Patients E all nely diagnosed patients hopresented ith stage III or I$ diseaseaccording to 7ILO staging criteria %(&<

patients)


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+:clusion E i they had already undergone PD#at an outside acility4 completed ->CT prior topresentation4 presented ith borderline orlo!grade histology4 or had stage I or II

disease The decision to oer PD# as a primary

treatment strategy as at the discretion othe individual surgical attending


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There ere no '2!day postoperative deaths ineither the PD# or ->CT cohort

There ere &2 %69) grade ' or 6 adverseevents in the entire cohort o (&< patients


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PDS NACT

*edianP7#

1.5 months%/(9 CI4 /.(01'.&)

'./ months%/(9 CI 1.(!


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• The best survivaloutcomes ere observedin patients ho achieveda complete grossresection at the time o

PD#4 although O# atercomplete gross resectionat the time o ID#%median O#4


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In this single!institution analysis4 the bestsurvival outcomes ere observed in patientsho ere deemed eligible or PD# olloed byplatinum!based chemotherapy

?ith improved optimal resection rates andless adverse event in ->CT4 they concludethat ->CT is reasonable treatment strategyor advanced ovarian cancer.


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pico pds vs nact

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