Optimal First-Line Medico-Surgical Strategy in Ovarian Cancers: Are We There Yet?

Simple Summary Cytoreductive surgery represents the cornerstone of the management of advanced epithelial ovarian cancers (aEOC). Currently, two alternative strategies coexist: either primary cytoreductive surgery (PCS) followed by adjuvant systemic therapy or neoadjuvant chemotherapy (NACT) followed by interval cytoreductive surgery (ICS). Although PCS and ICS exhibit distinct pros and cons, a univocal optimal strategy has not been reached yet. In this state-of-the-art review, we will describe achievements, ongoing data, and perspectives regarding the optimal medicosurgical strategy for aEOC. In spite of tremendous advances in advanced ovarian cancer management through the past decade, notably owing to surgical expertise and novel combination molecules (including bevacizumab and PARP inhibitors), the optimal initial sequential strategy remains a major concern. Indeed, following seminal clinical trials, primary cytoreductive surgery (PCS) followed by adjuvant systemic therapy and interval cytoreductive surgery (ICS) following neoadjuvant chemotherapy (NACT) have been positioned as validated alternatives with distinct pros and cons, although a definite response is still unassessed. In clinical practice, decisions between PCS and ICS rely on multilayer parameters: the tumor itself, the patient, and the health structure. In this state-of-the-art review, we will discuss the current evidence based on clinical trials and real-world data and highlight the remaining questions, including the fittest positioning of PCS vs. ICS and the optimal number of NACT cycles; subsequently, we will discuss current axes of research such as dedicated clinical trials and more global perspectives. These ongoing strategies and perspectives could contribute to improving the patient journey through personalized medicine.