Surgery Timing May Have ‘Little Effect’ on Time to Ovarian Cancer Disease Progression

While many patients with advanced epithelial ovarian cancer undergo cytoreductive surgery, the procedure, when followed by maintenance Zejula (niraparib) treatment, may actually have little effect on how long they live before their disease gets worse (known as progression-free survival), according to recent findings.

The data from the PRIMA study — which were published in the journal Gynecologic Oncology — showed comparable average progression-free survival durations for patients who underwent primary debulking surgery (surgery given upfront to remove visible tumors) then chemotherapy compared with those who had chemotherapy followed by interval debulking surgery (secondary surgery given after chemotherapy) paired with maintenance treatment with Zejula.

“Surgical timing had little effect on the risk of disease progression for patients receiving (Zejula) maintenance treatment after first-line chemotherapy in the PRIMA study,” the study authors wrote.

The investigators analyzed 236 patients with advanced ovarian cancer who underwent primary cytoreductive surgery then chemotherapy and 481 patients who received chemotherapy before surgery. Two-thirds of patients received maintenance Zejula, while the other third had treatment with a placebo.

The average progression-free survival for patients who underwent primary debulking surgery followed by maintenance Zejula was 13.7 months, compared to 8.2 months for those who were given a placebo after the procedure. For patients who underwent neoadjuvant chemotherapy then interval debulking surgery, average progression-free survival was 14.2 months and 8.2 months in the Zejula and placebo groups, respectively.

Regardless of when they received surgery, patients tended to have better outcomes when they were administered maintenance Zejula, a PARP inhibitor that is approved by the Food and Drug Administration to prevent ovarian cancer from coming back after initial treatment.

Prior research has shown that not only do PARP inhibitors not only improve progression-free survival times, but also allow ovarian cancer survivors to maintain a good quality of life, too.

“Maintenance (Zejula) extends (progression-free survival) in patients with poor prognostic factors, such as recipients of (neoadjuvant chemotherapy/interval debulking surgery), because of poor candidacy for initial surgery or extensive disease at the time of diagnosis,” the study authors wrote.

Ultimately, though, patients should discuss their individual cancer with their care team before deciding on when it is best to receive surgery.

“Selection of the best surgical approach for individual patients may depend on multiple tumor-related factors,” the authors concluded. “But according to these results, the surgical strategy will likely not affect the efficacy of maintenance (Zejula).”

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