Ovarian cancer(OC) is still the leading cause of gynaecological cancer mortality with 14,080 deaths estimated in 2017, according to national cancer institute[www.cancer.gov]. First line treatment in advanced stage is based on cytoreductive surgery plus platinum based chemotherapy. Patients who cannot immediately receive surgery, because of disease spread or general health condition, will be treated firstly with neoadjuvant chemotherapy (NACT) followed by cytoreduction. Residual tumor (RT) after surgery is the most important prognostic factor, thus the aim of NACT is to reduce the disease, allowing surgeon to remove all visible lesions[Polteraurer S 2012]. There is still not a marker to provide response to chemotherapy. Inflammation is involved in different tumour process. It seems that immunity cells in peripheral blood and in tumour tissue can regulate communication between malignant cells and human body, thus changing the course of the disease[Mantovani A 2008]. For this reason new possible markers of tumour progression or response to treatment have been tried in inflammation and immunity processes.
In particular, neutrophils to lymphocytes ratio (NLR) and monocytes to lymphocytes ratio (MLR) have recently been correlated to prognosis in different cancers, including ovarian neoplasia[Qi-tao Huanga 2017].
The aim of our study is to determine if NLR, MLR can provide response to NACT in advanced ovarian cancer.
Ovarian cancer is considered a chronic disease. First line therapy in advanced stage is based on surgery plus chemotherapy. When relapse occurred, second line therapy is chosen on platinum free interval (PFI); patients who relapse after 6 months will be retreated with a platinum based chemotherapy, others patients with a monotherapy of topotecan, gemcitabine, paclitaxel or doxorubicin.
First line therapy is based on 6 cycles of carboplatin with paclitaxel administered after surgery if upfront cytoreduction is performed. Women who will be submitted to NACT plus IDS will have 3 chemotherapy cycles before surgery. The aim of NACT is to reduce cancer to allow cytoreduction, as residual tumor is the main prognostic factor in advanced ovarian cancer.
Actually we cannot provide which patients will be responsive to NACT, thus it could be useful to find some markers that can offer gynaecologist information about response. We know that BRCA mutated patients respond better to chemotherapy but NLR, MLR and PLR are simple quickly markers, that could be calculated from routinely blood exams, thus if their predictive role will be demonstrated, no healthcare expenditure should be added.