The results of the CHORUS trial, published today in the Lancet, offer women with advanced ovarian cancer an alternative treatment option. Researchers at the MRC Clinical Trials Unit at UCL collaborating with a large number of hospitals around the UK, found that giving some chemotherapy before surgery may be better than giving all chemotherapy after surgery for many women with advanced disease.
Ovarian cancer is the leading cause of death from gynaecological cancer in developed countries. Over 75% of women with ovarian cancer have advanced disease (FIGO stage III or IV) when they are diagnosed. These women currently have a less than 25% chance of living for 5 years after their diagnosis.
The international standard of care for women with suspected advanced ovarian cancer is surgery followed by chemotherapy.
The CHORUS trial aimed to find out whether having some chemotherapy before surgery (neoadjuvant chemotherapy) was an acceptable alternative to the international standard of care.
552 women who were diagnosed with stage III/IV ovarian cancer took part in the trial, from hospitals across the UK and in New Zealand.
The trial found that giving some chemotherapy before surgery was non-inferior to (not worse than) the standard treatment in terms both of the numbers of women who survived overall, and the numbers of women who survived without their disease getting worse (progression-free survival). The results hint that women who had neo-adjuvant chemotherapy had slightly better progression free and overall survival.
Researchers also found that the women who were given some chemotherapy before surgery were less likely have severe side-effects from their chemotherapy and less likely to have complications after their operation. Additionally, they found that the surgery itself was more likely to be able to remove most of the tumour.
Professor Sean Kehoe, study author and professor of gynaecological cancer at the University of Birmingham, said: "The trial showed that shrinking the tumour before surgery reduced side effects and hospital stay - meaning improved quality of life, without compromising survival, which is better for patients. We are so thankful to the women who took part in the trial and their families, as we couldn't have done this important research without them. Because of their generosity we can improve the lives of others."
The CHORUS results support the increasing trend to treat women with advanced ovarian cancer with chemotherapy before surgery. This is a positive step in treating a form of cancer with a poor prognosis.
Matt Nankivell, statistician at MRC CTU at UCL, also emphasised that: "Chorus is the result of many years' work at a large number of centres across the UK. It is this sort of collaborative effort that provides the best clinical evidence and will ultimately lead to improved outcomes for patients."
CHORUS was funded by Cancer Research UK and the Medical Research Council. The Medical Research Council (MRC) and the Royal College of Obstetricians and Gynaecologists (RCOG) funded the feasibility phase of the trial.