# The Impact of the Number of Neoadjuvant Chemotherapy Cycles on Outcomes in Advanced Ovarian Cancer: A Narrative Review

## TL;DR

This review examines how the number of neoadjuvant chemotherapy cycles affects outcomes in advanced ovarian cancer patients.

## Contribution

The paper provides a narrative review of real-world evidence on the impact of extended neoadjuvant chemotherapy cycles in ovarian cancer.

## Key findings

- Classic studies recommend three to four chemotherapy cycles before surgery, but real-world practice often exceeds this.
- Extended chemotherapy may lead to resistant tumor clones, potentially worsening survival and disease progression.
- The literature remains inconclusive on the relationship between chemotherapy cycles and oncologic outcomes.

## Abstract

Ovarian cancer is the gynecologic malignancy with the highest mortality rate. Standard treatment is based on complete surgical resection combined with platinum-based chemotherapy. In cases of advanced disease or in patients with impaired clinical status, neoadjuvant chemotherapy may be considered as a therapeutic strategy, followed by interval debulking surgery. Classic studies recommend the administration of three to four cycles of chemotherapy before surgical intervention. However, in real-world practice, this number is often exceeded, and the literature remains inconclusive regarding the relationship between the number of neoadjuvant cycles and oncologic outcomes.

Although standard chemotherapy for three to four cycles followed by surgery is considered safe and effective in the management of advanced ovarian cancer, the impact of extending treatment beyond this period remains uncertain. Some authors suggest that the number of neoadjuvant chemotherapy cycles does not directly affect prognosis and may reflect a confounding bias. Others, however, indicate that a prolonged exposure to chemotherapy can promote the selection of resistant tumor clones, negatively influencing patient survival and disease progression. This review aims to summarize the current evidence on the topic, evaluating the effect of prolonged chemotherapy on surgical cytoreduction and survival. To achieve this, we conducted an analysis of the English-language literature available in PubMed, focusing on treatment duration, achievement of complete surgical resection, survival outcomes, and prognostic factors.