The presentation that I’ve done is relating to the use of neoadjuvant chemotherapy in advanced ovarian cancer. Neoadjuvant chemotherapy – two big trials, one which I ran called CHORUS and an EORTC trial which was a European trial run by Ignace Vergote, are the two largest trials that have been reported on giving chemotherapy as an alternative to primary surgery in advanced ovarian cancer. The question that I was posed, what I was asked to talk about, is who should have that kind of therapy? Both trials showed that you can use it, the chemotherapy, first or the surgery first the outcomes are the very, very same, but there has been quite a marked increase in the use of neoadjuvant chemotherapy. It’s averaging, if you look at the figures from the UK, the bits you can get from the United States and Denmark, about a quarter of the patients now are having this thing called neoadjuvant chemotherapy which is a four- to fivefold increase in the last ten years or so of its use. Who should have that, who is preferable? We brought the two, the European EORTC study and CHORUS, together, this was all pre-planned many years ago, and what we found was that in women with stage 4 disease their overall survival was improved if given neoadjuvant chemotherapy.

Now, whilst that may well not be for every single stage 4 patient the evidence is there so you should be thinking about neoadjuvant chemotherapy for those patients. The other cohort of patients that neoadjuvant chemotherapy can be preferable is in those who have got a poor performance status and in that type of a situation if you measure the patient’s quality of life if they respond to treatment you find their quality of life improves, their performance improves and it then becomes safer to operate on them. So they’re the two main cohorts of patients I’ve suggested that they should be viewed and given consideration for neoadjuvant chemotherapy, stressing that we are talking about patients with advanced disease, usually a bit elderly, usually the performance status isn’t very good, and specifically it relates to high grade serous ovarian cancer. This is not for every advanced ovarian cancer, that’s quite important to stress, as some of the advanced cases are different tumour types and some of those different tumour types you should make a very major surgical effort to get all the disease out. So I specifically want to stress that the studies, both of them, really incorporate just high grade serous ovarian cancer patients.

So that again is a shift, we only published about the outcomes of the stage 4 patients in Lancet Oncology that just came out in December of last year. So that’s the first time we’ve proven, or shown as best we can, that neoadjuvant chemotherapy is a preferable therapy compared with surgery, as I say, in those stage 4 patients alone.