Primary debulking surgery [PDS] followed by paclitaxel/platinum - based chemotherapy represents the standard treatment for patients with advanced epithelial ovarian cancer [EOC]. Current regimens are able to obtain a clinical complete response rate of 50% approximately, a pathological complete response rate of 25-30%, a median progression-free survival [PFS]of 15.5–22 months, and a median overall survival [OS] of 31-44 months (1-8). Paclitaxel plus cisplatin and paclitaxel plus carboplatin are equally effective, with the carboplatin combination being well tolerated (2, 6, 7 , 9). Two randomized phase III clinical trials showed that the addition of concomitant and maintenance bevacizumab to paclitaxel/ carboplatin based chemotherapy significantly improved PFS, without any advantage in OS (10,11). Main differences between GOG 210 and ICON-7 trials regarded eligibility criteria, investigational arms, and drug dosing, but both trials met .their primary end-point PFS, and therefore the combination BEV and chemotherapy represents a rational therapeutic option for advanced EOC. However, until biological characterization of EOCs has not identified subsets of tumors with different responsiveness to anti-angiogenic drugs , it will be difficult to accept that the addition of bevacizumab to chemotherapy represents the new standard treatment (13-15).
Although optimal residual disease [RD] after PDS has been variously defined as ranging from tumor lesions ≤ 2cm to no gross RD, more contemporary data suggest that the most favorable survival outcomes are associated with the removal of all macroscopically detectable disease (16-19). A meta-analysis of 18 relevant studies including 13,257 patients treated with platinum-taxane based- chemotherapy showed that each 10% increase in the proportion of patients undergoing complete cytoreduction to no gross RD was associated with a significant and independent 2.3-month increase (95%CI = 0.6-4.0, p = 0.011) in median OS compared to a 1.8-month increase (95%CI = 0.6-3.0, p = 0.004) in median OS for optimal cytoreduction to RD ≤1cm (19)
