Timing of Surgery for Advanced Ovarian Cancer among Neoadjuvant and Adjuvant Chemotherapy Cycles: Early Findings from Randomized CHRONO Trial
An interview with:
Jean-Marc Classe, MD PhD, Surgeon in Gynecological Oncology, Professor of Oncology, Nantes University, France.
(Chirurgien, PUPH Oncologie, Prof. Dépt Chirurgie Oncologique, Chirurgien, PUPH Oncologie, Prof. Dépt Chirurgie Oncologique, Institut de cancérologie de l’Ouest ICO, Nantes Université, Nantes, France)
CHICAGO, USA—In patients with advanced ovarian cancer who needed neoadjuvant chemotherapy to prepare for surgery, the French multi-center phase 2 CHRONO trial investigated the timing of surgery among cycles of neoadjuvant and adjuvant chemotherapy.
The findings were reported at the 2026 Annual Meeting of the American Society of Clinical Oncology by Jean-Marc Classes, MD PhD, Surgeon in Gynecologic Oncology and Professor of Oncology at Nantes University in France. Peter Goodwin met up with him afterwards:
AUDIO JOURNAL OF ONCOLOGY; Jean-Marc Classe MD PhD
IN: [GOODWIN] “Peter Goodwin here..….
OUT: …… of Oncology, I’m Peter Goodwin. 9:04secs
ASCO 2026 ABSTRACT Number: 5505
CHRONO: A randomized phase II trial of the chronology of surgery after neoadjuvant chemotherapy for ovarian cancer.
FIRST AUTHOR: Gwenael Ferron
Institut Claudius Regaud, IUCT-Oncopole and GINECO, Toulouse, France
PRESENTER
Jean-Marc Classe, MD, PhD
All Author Details & Organizations
Meeting
2026 ASCO Annual Meeting
Session Title
Gynecologic Cancer
Session Type
Oral Abstract Session
Citation
J Clin Oncol 44, 2026 (suppl 16; abstr 5505)
AUTHORS:
Gwenael Ferron
Pierre-Francois Dupre
Constantin Georgeac
Claire Cropet
Pierre Meeus
Christophe Pomel
Claire Bonneau
Lobna Ouldamer
Sheik Emambux
Hélène Costaz
Sandrine Martin
Sebastien Gouy
Pierre-Emmanuel Colombo
Anne-Sophie Bats
Johanna Wassermann
Vincent Villefranque
Isabelle Cumin
Cyriac Blonz
Tristan Gauthier
Jean-Marc Classe
Organizations:
Institut Claudius Regaud, IUCT-Oncopole and GINECO, Toulouse, France,
CHU de Brest- Hôpital Cavale Blanche, Brest, France,
Institut inter-régionaL de Cancérologie – Centre Jean Bernard, Le Mans, France, Department of Biostatistics, Centre Léon Bérard, Lyon, France,
Centre Léon Bérard and GINECO, Lyon, France,
Centre Jean Perrin and GINECO, Clermont Ferrand, France,
Department of Surgical Oncology, Institut Curie – Saint-Cloud, University of Versailles Saint-Quentin en Yvelines, INSERM U1331, Institut des Cancers de la Femme, Saint-Cloud, France
and GINECO, Paris and St Cloud, France, Department of Medical Oncology, Centre Hospitalo-Universitaire Bretonneau, Tours, France,
Centre Hospitalier Universitaire de Poitiers, Poitiers, France,
Georges François Leclerc Comprehensive Cancer Care Centre, Dijon, France,
Centre François Baclesse and GINECO, Caen, France, Gustave Roussy Cancer Center and GINECO, Villejuif, France,
Department of Surgical Oncology, Montpellier Cancer Institute (ICM), Montpellier, France;
Inserm U1194, Montpellier Cancer Research Institute (IRCM), University of Montpellier and GINECO, Montpellier, France,
Hôpital Européen Georges Pompidou, Paris, France, Hôpital Pitié-Salpêtrière, Paris, France,
Departments of Obstetrics and Gynecology, Hôpital Simoine Veil, Eaubonne, France,
Groupe Hospitalier Bretagne Sud – Hôpital du Scorff, Lorient, France,
Hôpital Privé du Confluent and GINECO, Nantes, France,
CHU Limoges, Hopital de la Femme, de la mère et de l’Enfant, Limoges, France,
Institut de Cancérologie de l’Ouest and GINECO, Saint-Herblain, France
Background:
In patients treated for advanced ovarian cancer not suitable for complete primary surgery, interval surgery after three courses of neoadjuvant chemotherapy (NAC) has been considered standard management since the EORTC randomized trial published in 2010 (NCT00003636, DOI: 10.1056/NEJMoa090880). Delaying surgery after six courses of NAC in highly chemosensitive patients amenable to complete surgery after 3 cycles remains controversial. CHRONO is a multicenter, randomized phase II trial addressing this question (NCT03579394).
Methods:
Patients treated for a stage IIIB-IVA high grade epithelial ovarian cancer by NAC and amenable to complete surgery after 3 cycles were randomized (1:1) to either complete surgery followed by 5 cycles of chemotherapy (control arm: C) or an additional 3 cycles of NAC followed by complete surgery then 2 cycles of chemotherapy (experimental arm: E). Maintenance treatment was administered according to standard of care. Primary endpoint was disease free survival (DFS) defined as the time from randomization until the date of disease progression or second cancer or death from any cause. The study was designed to detect an improvement in median (m) DFS from 10 months to 17 months (HR=0.59) with a 85% power and 2-sided α=0.05. Main secondary endpoints were Pathological complete response (CC0) rate, post operative morbidity and mortality, quality of life (QOL) and overall survival (OS).
Results:
Between 18/10/2018 and 23/04/2024, 209 patients (median age: 69 years) were randomized to arm C (n=103) or E (n=106). Median total number of cycles of NAC was 7 (5-9) and 8 (3-9) in arm C and E .CC0 rate was 83.2% vs 90%. After a median follow up of 40.4 months, mDFS was 20.2 months (95%CI: 18.2-23.6) in arm C vs 23.4 (19.0-30.4) in arm E (Log-rank test p=0.48, HR: 0.88 (95%CI: 0.63-1.24). The longitudinal analysis of QoL found no significant differences between the two arms, however, social functioning, insomnia, and sexuality showed a trend toward further improvement (≥5 points) in arm E. Major postoperative complication rates within 30 days were 5% and 11% in arm C and E, (p=0.11) , with no death within 30 days after surgery.
Conclusions:
CHRONO is the first randomized trial addressing the clinical impact of delayed surgery after 6 courses of NAC in first line treatment of advanced ovarian cancer. No statistically significant difference was shown between the two arms of the study considering DFS, severe morbidity, mortality or QoL. New trials are needed for a better understanding of this alternative to interval surgery in highly chemosensitive advanced ovarian cancer patients.
260608: Jean-Marc Classe MD PhD Audio Journal of Oncology TEXT
