Cytoreductive surgery for recurrent ovarian cancer improves survival in well-selected patients
Harter P, Sehouli J, Vergote I, et al; DESKTOP III Investigators. Randomized trial of cytoreductive surgery for relapsed ovarian cancer. N Engl J Med. 2021;385:2123- 2131.
In the DESKTOP III trial, Harter and colleagues contribute results to the ongoing discourse surrounding treatment options for patients with recurrent, platinum-sensitive ovarian cancer.3 Systemic therapies continue to be the mainstay of treatment in this setting; however, several groups have attempted to evaluate the role of secondary cytoreductive surgery in this setting.4,5
Specific inclusion criteria employed
The DESKTOP III investigators randomly assigned 407 patients with platinum-sensitive recurrent ovarian cancer to secondary cytoreductive surgery followed by platinum-based chemotherapy (n = 206) or platinum-based chemotherapy alone (n = 201).3 An essential aspect of the study’s design was the use of specific inclusion criteria known to identify patients with a high likelihood of complete resection at the time of secondary cytoreduction.6,7 Patients were eligible only if they had at least a 6-month remission following platinum-based chemotherapy, had a complete resection at their previous surgery, had no restriction on physical activity, and had ascites of no more than 500 mL.
Surgery group had superior overall and progression-free survival
After a median follow-up of approximately 70 months, patients randomly assigned to surgery had superior overall survival (53.7 months) compared with those assigned to chemotherapy alone (46.0 months; HR, 0.75; 95% CI, 0.59–0.96).3 Progression-free survival also was improved among patients who underwent surgery (median 18.4 vs 12.7 months; HR, 0.66; 95% CI, 0.54–0.82). Subgroup analyses did not identify any subset of patients who did not benefit from surgery. Whether a complete resection was achieved at secondary cytoreduction was highly prognostic: Patients who had a complete resection had a median overall survival of 61.9 months compared with 27.7 months in patients with residual disease. There were no deaths within 90 days of surgery.
WHAT THIS EVIDENCE MEANS FOR PRACTICE
The DESKTOP III trial provides compelling evidence that secondary cytoreductive surgery improves overall and progression-free survival among well-selected patients with recurrent, platinum-sensitive ovarian cancer. These results differ from those of a recently reported Gynecologic Oncology Group (GOG) trial that failed to detect a survival benefit for secondary cytoreductive surgery among patients with platinum-sensitive recurrent ovarian cancer.5 Key differences, which might explain the studies’ seemingly contradictory results, were that the GOG study had fewer specific eligibility criteria than the DESKTOP III trial, and that bevacizumab was administered much more frequently in the GOG study. It is therefore reasonable to discuss the possible benefits of secondary cytoreductive surgery with patients who meet DESKTOP III eligibility criteria, with a focus toward shared decision making and a candid discussion of the potential risks and benefits of secondary cytoreduction.
The DESKTOP III trial provides compelling evidence that secondary cytoreductive surgery improves overall and progression-free survival among well-selected patients with recurrent, platinum-sensitive ovarian cancer. These results differ from those of a recently reported Gynecologic Oncology Group (GOG) trial that failed to detect a survival benefit for secondary cytoreductive surgery among patients with platinum-sensitive recurrent ovarian cancer.5 Key differences, which might explain the studies’ seemingly contradictory results, were that the GOG study had fewer specific eligibility criteria than the DESKTOP III trial, and that bevacizumab was administered much more frequently in the GOG study. It is therefore reasonable to discuss the possible benefits of secondary cytoreductive surgery with patients who meet DESKTOP III eligibility criteria, with a focus toward shared decision making and a candid discussion of the potential risks and benefits of secondary cytoreduction.
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