First Line Chemo for Advanced (Stage III & IV) Disease

Question 1

Preferred initial management

Answer 1

Primary surgical reduction followed by systemic chemo (carboplatin & paclitaxel)

Question 2

Modalities

Answer 2

IV alone OR IV plus IP therapy
Optimally cytoreduced EOC: IV/IP
Suboptimally reduced EOC: dose dense IV Tx

Question 3

Neoadjuvant therapy

Answer 3

• Admin systemic chemo before definitive surgery, goal is to increase liklihood of resection at time of cytoreduction
• Candidates:
  1. Poor operative candidates (medical or performance status)
  2. Advanced EOC (Stage IIIC OR IV) w/clinically apparent unresectable disease
• Surgical cytoreduction if there is a chance of resecting all disease after NACT
• Post surgery –> adjuvant platinum based chemo (carboplatin and paclitaxel)