Potential survival benefits from optimized chemotherapy implementation in advanced ovarian cancer: Projections from a microsimulation model

• Published in: PloS one Vol. 14; no. 9; p. e0222828
• Main Authors: Lietz, Anna P, Weaver, Davis T, Melamed, Alexander, Rauh-Hain, Jose Alejandro, Wright, Jason D, Wright, Alexi A, Knudsen, Amy B, Pandharipande, Pari V
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 20-09-2019; Public Library of Science (PLoS)
• Subjects: Adjuvant chemotherapy; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bevacizumab; Bevacizumab - administration & dosage; Biology and Life Sciences; Cancer; Cancer therapies; Cancer treatment; Care and treatment; Chemotherapy; Combined Modality Therapy; Computer simulation; Cytoreduction Surgical Procedures - methods; Debulking; Diagnosis; Disease-Free Survival; Drug dosages; Drug Therapy - methods; Female; Gynecology; Hospitals; Humans; Intravenous administration; Kaplan-Meier Estimate; Life expectancy; Life span; Medical prognosis; Medicine and Health Sciences; Middle Aged; Monoclonal antibodies; Obstetrics; Oncology; Ovarian cancer; Ovarian carcinoma; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - surgery; Patients; Physical Sciences; Research and Analysis Methods; Retirement benefits; Sensitivity analysis; Surgery; Survival; Targeted cancer therapy; Womens health; United States > US; Massachusetts
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0222828

Ovarian cancer is often diagnosed in advanced stages, when survival is poor. Treatment advances have been made, but are inconsistently implemented. Our purpose was to project the maximum life expectancy gains that could be achieved in women with stage IIIC epithelial ovarian cancer if the implementation of available chemotherapy regimens could be optimized.
We used a microsimulation model to estimate life expectancy benefits associated with "optimized" implementation of four post-operative chemotherapy options: standard intravenous chemotherapy; intraperitoneal + intravenous chemotherapy; bevacizumab + intravenous chemotherapy; and hyperthermic intraperitoneal chemotherapy + intravenous chemotherapy. Optimized implementation was defined as follows. Patients triaged to primary cytoreductive surgery received intraperitoneal + intravenous chemotherapy if optimally or completely cytoreduced, and bevacizumab + intravenous chemotherapy if suboptimally cytoreduced. Patients triaged to neoadjuvant chemotherapy received hyperthermic intraperitoneal chemotherapy at interval cytoreductive surgery if optimally or completely cytoreduced, and standard IV chemotherapy if suboptimally cytoreduced. Life expectancy associated with optimized implementation was compared with that of current utilization practices, estimated using published literature and the National Cancer Database. Effects of model uncertainty were evaluated in sensitivity analyses.
Life expectancy associated with optimized implementation vs. current practice was 76.7 vs. 64.5 months (life expectancy gain = 12.2 months). Providing intraperitoneal + intravenous chemotherapy to all eligible patients was the largest driver of life expectancy gains, due to both the potential benefit conferred by intraperitoneal + intravenous chemotherapy and the proportion of eligible women who do not receive intraperitoneal + intravenous chemotherapy in current practice.
Population-level life expectancy in stage IIIC epithelial ovarian cancer could be substantially improved through greater uptake of available chemotherapy regimens.