MedicalResearch.com Interview with:
Mr Matthew Nankivell
MRC Clinical Trials Unit at University College London
Institute of Clinical Trials and Methodology
Aviation House, London
Medical Research: What is the background for this study? What are the main findings?
Response: Ovarian cancer is diagnosed in over 7000 women each year in the UK. Over 75% of these already have advanced disease, for which the standard treatment is surgery followed by platinum based chemotherapy. The prognosis for these patients remains poor however, with less than 25% surviving for 5 years. There is consistent evidence that achieving optimal debulking (meaning less than 1cm of residual tumour after surgery) is key to increasing survival. The theory tested in Chorus is that giving the chemotherapy before surgery (neo-adjuvantly) would be as least as effective as giving it post-operatively, and may in fact increase the chance of achieving optimal debulking, and subsequently living for longer.
In Chorus we randomised 552 women to receiving either the current standard of immediate surgery followed by chemotherapy, or chemotherapy followed by surgery. The trial met its primary aim of showing that neo-adjuvant chemotherapy was no worse than post-operative chemotherapy, with median survival times of 24.1 and 22.6 months respectively. The proportion of women achieving optimal debulking increased from 41% in the post-operative chemotherapy group to 73% in the neo-adjuvant chemotherapy group. Additionally we saw that fewer women experienced serious post-operative complications having had neo-adjuvant chemotherapy (14% vs 24%), and fewer women died within 28 days of surgery (<1% vs 6%).
There is a planned meta-analysis, to combine the data from Chorus with those from a similar European trial, which will allow further investigations to take place, and may allow the identification of groups of women who are more likely to benefit from one or other of the approaches.
Medical Research: What should clinicians and patients take away from your report?
Response: Delaying surgery by administering neo-adjuvant chemotherapy does not have a negative effect on the prognosis for patients. In addition, it may make the operation and subsequent recovery period easier for women. If the goal of surgery remains to achieve optimal debulking, then neo-adjuvant chemotherapy is a viable and valuable alternative to the current standard of immediate surgery.
Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial
Prof Sean Kehoe, MDJane Hook, MRC Matthew Nankivell, MSc Prof Gordon C Jayson, FRCP Prof Henry Kitchener, MD Tito Lopes, MD Prof David Luesley, MD Prof Timothy Perren, MD Selina Bannoo, MSc Monica Mascarenhas, PhD Stephen Dobbs, M Sharadah Essapen, MD Jeremy Twigg, MD Jonathan Herod, Prof Glenn McCluggage, MD Prof Mahesh Parmar, DPhil Prof Ann-Marie Swart, MSc Published Online: 19 May 2015
The Lancet Published Online: 19 May 2015
MedicalResearch.com Interview with:, & Mr Matthew Nankivel (2015). Chemotherapy Before Ovarian Cancer Surgery May Benefit Some Patients