
Alex Melamed
Gynecologic oncologist and clinical outcomes researcher at Massachusetts General Hospital and Associate Professor at Harvard Medical School.
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Sep 1, 2026
Revisited: Neoadjuvant Chemotherapy: Mortality in Low- vs High-Volume Centers
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Pedro RamirezHOST
So let's actually start by discussing what was the initial impetus for exploring this question? In other words, why did you think this topic was important? And what specific question was unanswered in the literature that you felt that this would fill that gap?

Alex MelamedGUEST
Well, so, you know, I've been really interested in studying neoadjuvant chemotherapy for advanced ovarian cancer for a long time.

Alex MelamedGUEST
And it's a question that, you know, I and close collaborators, you included, have looked at from different angles.

Alex MelamedGUEST
You know, I had really come to the conclusion based on the randomized evidence and the observational work that we had done that, you know, that this overwhelmingly clear that patients with advanced ovarian cancer don't seem to be harmed by getting neoadjuvant chemotherapy in terms of their long-term outcomes, and that many patients have benefits in terms of short-term outcomes.

Alex MelamedGUEST
And so the question that came to my mind was, in what settings is neoadjuvant chemotherapy the most beneficial, right? In what settings is it the most important that physicians appropriately pick patients to get neoadjuvant chemotherapy? And there was a paper probably like 10 or 15 years ago old in jco led by dr jason wright that had found it was a paper about failure to rescue in ovarian cancer surgery and it was about for patients who have a complication after ovarian cancer surgery who ultimately does okay and who, you know, ends up having a severe, you know, who ends up dying after a surgical complication.
30 MINS LATER

Pedro RamirezHOST
Do you think we're still using too little neoadjuvant chemotherapy in clinical practice?