Findings from a randomized, multicenter phase 3 trial show that cytoreductive surgery followed by chemotherapy in recurrent ovarian cancer patients resulted in longer overall survival than chemotherapy alone. However, questions remain regarding which patients may benefit the most from this procedure. The results of the DESKTOP III study were published Dec. 2, 2021, in The New England Journal of Medicine.
Cytoreductive surgery is a common procedure in advanced stage, newly diagnosed ovarian cancer that removes as much cancerous tissue as possible by taking out all tumor nodules larger than one centimeter in diameter. Many studies validate cytoreductive surgery as a primary treatment, but DESKTOP III was one of few to evaluate it as a secondary therapy for patients who had previously received cytoreductive surgery for their ovarian cancer but had seen their cancer recur.
Patients were eligible for the study if they had a positive Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) score. To have a positive AGO score, patients must have an Eastern Cooperative Oncology Group performance-status score of 0 based on a five-point scale, ascites (fluid collecting in spaces in the abdomen) of less than 500 milliliters, and full resection of their cancer in the initial surgery. This positive AGO score can help identify patients for whom a complete resection may be achieved with surgery.
Researchers from centers in Europe, China, and South Korea randomly assigned 206 patients to receive cytoreductive surgery and platinum-based chemotherapy and 201 patients to receive platinum-based chemotherapy alone. The primary endpoint was overall survival.
In the cohort receiving surgery, a complete resection was achieved in 75.5% of patients. The median overall survival was 53.7 months for patients who received surgery followed by chemotherapy, versus 46.0 months in those who were given chemotherapy alone. Patients who had a complete resection had a median overall survival of 61.9 months.
“We now have high-quality data from a large multicenter randomized trial that shows that we should be offering surgery to women who have a positive AGO score with platinum-sensitive, first-relapse ovarian cancer,” said Sadaf Ghaem-Maghami, MBBS, PhD, chair of gynecological oncology at Imperial College London and a study author.
These findings differ from those of a U.S.-based Gynecologic Oncology Group study, GOG-0213, that found a second cytoreductive surgery followed by chemotherapy for recurrent ovarian cancer did not provide a survival benefit compared to chemotherapy alone. Findings from the study published in 2019 showed that patients who received surgery followed by chemotherapy had a median overall survival of 50.6 months, compared to 64.7 months in patients who were given chemotherapy alone.
Dennis Chi, MD, head of ovarian cancer surgery at Memorial Sloan Kettering Cancer Center in New York City, and co-author of an editorial on DESKTOP III published alongside the new paper, said there were significant differences in the two trials. For example, GOG-0213 did not have as strict a criterion for selecting participants as DESKTOP III because one had not been established at the time the former trial started. There was also a difference in the criteria for the selection of the trial sites, as the DESKTOP III study was conducted in larger cancer centers.
“The take home message in trying to reconcile these two well done trials is what we often see in medicine. One size does not fit all. In appropriately selected patients, the addition of secondary cytoreduction to chemotherapy does offer a survival benefit to patients with platinum-sensitive ovarian cancer when performed in expert centers,” he said.
This study was supported by the AGO Study Group, GlaxoSmithKline, and Medac.
Neither Prof. Ghaem-Maghami nor Dr. Chi reported relevant relationships.
