Despite aggressive treatment changes and screening practices, long term survival in patients with epithelial ovarian cancer (EOC) has remained unchanged in the last 25 years.

By Marielle Fares, Pharm. D

January 26, 2018- In early-stage and advanced-stage EOC patients, respective improvements in surgical staging practices and in chemotherapy treatment did not result in increased long-term survival, a population-based study showed.

  1. Timmermans, M.D with the Department of Research at the Netherlands Comprehensive Cancer Organization (IKNL) in Utrecht, the Netherlands, and with the GROW-School of Oncology and Development Biology at the Maastricht University Medical Centre in Maastricht, the Netherlands, and colleagues reported their results in the November 25, 2017 issue of the European Journal of Cancer.

EOC has traditionally been treated with debulking surgery (DBS) followed by chemotherapy. In recent years, neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) has increasingly been used in advanced disease. In addition, current guidelines recommend thorough diagnostic and surgical staging for patients in early stage disease. This study examined long-term survival in relation to these changes in treatment over the last 25 years.

A total of 32,540 patients were selected from the Netherlands Cancer Database between 1989 and 2014, and grouped in 4-year time periods. The primary endpoint of OS was calculated as time to death from diagnosis or last follow-up. Longitudinal trends in therapy and survival were studied separately in each of the early-stage and advanced-stage patient groups.

According to the study findings, significantly more patients with early-stage disease underwent surgical staging in the form of lymph node dissections in 2009-2014 compared with previous years (4% in 1989-1993 and 62% in 2009-2014, p<0.001). Similarly, NACT-IDS treatment was offered in advanced disease to a larger number of patients when compared with primary debulking surgery, the standard of care before 2009.

The 5-year OS significantly increased when measured separately in each of the early-stage and advanced-stage patient groups as well as in all patients combined but did not improve in the total number of patients combined.  While 5-year OS improved until 2003 in all patients (31% in 1989-1993 and 35% in 1999-2003), it remained stable at 35% from 2004 until 2009.

Similarly, the 10-year OS did not improve and the cure rate of EOC remained the same when compared with earlier periods (24% in 1989-1993 and 24% in 2004-2008). “The improved treatment options and surgical staging “resulted in prolonged disease control, as shown by the improved short-term survival, but not in better cure rates,” according to the study authors.

“Despite all efforts in intensifying treatment, this study showed that overall long-term survival for patients diagnosed with EOC has not improved in the last 25 years,” the authors concluded.

This study was supported by the Dutch Cancer Society.

European Journal of Cancer. Published November 25, 2017.