Top Line: Does secondary cytoreductive surgery improve survival for patients with relapsed, platinum sensitive ovarian cancer?
The Study: The role of secondary cytoreductive surgery for platinum sensitive (> 6 months since platinum) relapsed ovarian cancer has been a long-running debate. Here, SOC-1 becomes the third large randomized trial to inform management of this patient population. Previously, GOG-0213 demonstrated no improvement in median overall survival with cytoreductive surgery + chemo (50.6 months) compared to chemo alone (64.7 months). In contrast, DESKTOP-III did show a significant improvement in median OS with surgery compared to chemo alone (46→ 53.7 months). The difference in mOS from these trials is interesting given the fact that median PFS was superior with surgery + chemo in both. In SOC-1, there was also a significant improvement in median PFS from 11.9→ 17.4 months. OS results were not mature in this report, but interim results showed mOS of 58.1 months with surgery versus 53.9 months without. So, what’s different among these trials? All 3 required eligible patients to have “resectable” disease, but while DESKTOP-III and SOC-1 had objective resectability criteria, the GOG trial relied on the surgeon’s discretion for resectability. The R0 resection rates for each trial were 75%, 77%, and 67%, respectively. Another key difference was that the majority of patients in GOG-0213 (84%) had maintenance therapy (bevacizumab), but just 23% in DESKTOP-III and a mere 10% in SOC-1 received maintenance therapy. The final take away from all three trials was that patients who have incomplete resection do worse than those who have no resection at all--underlining the importance of patient selection for this treatment approach.
TBL: Secondary cytoreductive surgery for platinum sensitive, relapsed ovarian cancer improves PFS with mixed results for OS that are likely influenced by patients selection and maintenance therapy. | Shi, Lancet Oncol 2021