MD Anderson Has It Going On!

I just heard this interview with Dr. Depinho, president of MD Anderson Cancer Center.  He talks about your Moon Shots program.  One example he gave was gaining the  knowledge that doing chemo first for ovarian cancer increases the “R0”status from 20% to 89%.  http://www.eab.com/daily-briefing/2014/11/07/business-major-blues-lack-of-purpose-and-guidance?elq_cid=1283120 . 

Dr Depinho, skipped over some important details. The patient group he is talking about are those patients with very widespread, non-resectable disease. Those patients are almost impossible to surgically reduce to what he calls "R0", or no residual disease. But, if you give those patients chemo first, the burden of disease goes down and they become better candidates for surgery. And it's much easier for the surgery to be "R0".

Dr Depinho is NOT talking about all ovarian patients, only the subgroup with non-resectable disease. There are a number of papers in the literature that look at this question in a wider group of patients, and the conclusion is that chemo before surgery (neoadjuvant chemo), confers no survival advantage, unless you have non-resectable disease. Many studies have shown this to be the case. Here's an extract from a very recent paper (September 2014 issue of Gynecologic Oncology):

"The impacts of neoadjuvant chemotherapy and of debulking surgery on survival from advanced ovarian cancer"

Highlights:
• Neoadjuvant chemotherapy is associated with an inferior survival compared to primary debulking surgery.
• Optimal debulking is achieved when there is no visible residual disease.
• Aggressive surgical techniques can contribute to the achievement of no residual disease.

Conclusions:
Neoadjuvant chemotherapy should be reserved for ovarian cancer patients who are not candidates for primary debulking surgery. Among women with no residual disease after primary debulking surgery, intraperitoneal chemotherapy extends survival.