Disclosures: Harter reports grants from and/or a consultant role with AstraZeneca, Clovis Oncology, F. Hoffmann-La Roche, Genmab, GlaxoSmithKline, Immunogen, Medac Pharma, Merck, Stryker and ZaiLab and a data and safety monitoring board role with Sotio. Please see the study for all authors’ relevant financial disclosures. Chi reports consultant/advisory board roles with Apyx Medical Corporation and Biom’Up France, a speaker role with AstraZeneca, and stock or stock options in BioNTech SE, Moderna and Vertthermia Acquio Inc. Gardner reports no relevant financial disclosures.
December 02, 2021
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Cytoreductive surgery before chemotherapy benefits women with recurrent ovarian cancer

Disclosures: Harter reports grants from and/or a consultant role with AstraZeneca, Clovis Oncology, F. Hoffmann-La Roche, Genmab, GlaxoSmithKline, Immunogen, Medac Pharma, Merck, Stryker and ZaiLab and a data and safety monitoring board role with Sotio. Please see the study for all authors’ relevant financial disclosures. Chi reports consultant/advisory board roles with Apyx Medical Corporation and Biom’Up France, a speaker role with AstraZeneca, and stock or stock options in BioNTech SE, Moderna and Vertthermia Acquio Inc. Gardner reports no relevant financial disclosures.
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Cytoreductive surgery before chemotherapy led to significant and clinically meaningful OS and PFS benefits for women with recurrent ovarian cancer, according to a phase 3 study published in The New England Journal of Medicine.

“The role of surgery in relapsed ovarian cancer has not been well defined,” Philipp Harter, MD, PhD, of the department of gynecology and gynecologic oncology at Kliniken Essen-Mitte in Germany, and colleagues wrote. “We initiated the Descriptive Evaluation of Preoperative Selection Criteria for Operability in Recurrent Ovarian Cancer (DESKTOP) series when the evidence consisted only of retrospective trials in heterogeneous populations that suggested a benefit of surgery in patients with platinum-sensitive relapsed disease.”

Median overall survival.
Data derived from Harter P, et al. N Engl J Med. 2021;doi:10.1056/NEJMoa2103294.

The prospectively randomized DESKTOP III study included 407 women with recurrent ovarian cancer. As Healio previously reported, researchers randomly assigned women to second-line chemotherapy alone (n = 201; median age, 62.2 years) or secondary cytoreductive surgery followed by chemotherapy (n = 206; median age, 60.8 years).

Median follow-up was 69.8 months.

According to study results, 75.5% of women who underwent surgery had a complete resection. Median OS was 53.7 months in the surgery group vs. 46 months in the nonsurgical group (HR = 0.75; 95% CI, 0.59-0.96). Women who underwent surgery also had longer median PFS (18.4 months vs. 14 months; HR = 0.66; 95% CI, 0.54-0.82).

Among women who achieved complete resection with surgery, researchers observed median OS of 61.9 months, whereas women who underwent surgery with incomplete resection had shorter median OS (27.7 months).

“We practice in era of expanded molecular understanding of tumor biology and an ever-increasing opportunity for targeted therapy,” noted Ginger J. Gardner, MD, FACOG, surgeon and vice chair of hospital operations in the department of surgery, and Dennis S. Chi, MD, FACOG, FACS, surgeon, Ronald O. Perelman chair in gynecologic surgery, deputy chief of gynecology service and head of ovarian cancer surgery in the department of surgery, both at Memorial Sloan Kettering Cancer Center, in an editorial that accompanied the study.

“If we truly seek to cure ovarian cancer, we need to bring our entire toolbox to the table,” they wrote. “We need to use precision in the selection of medical and surgical options — the right treatment for the right patient. We commend the authors, investigators and patients who participated in the DESKTOP III study for their roles in a high-quality trial in which personalized medicine does not just apply to medical therapy, but to surgical therapy as well. Now is the time to move toward a cure for ovarian cancer and to use all of our best talents to do it.”

References:

Gardner GJ and Chi DS. N Engl J Med. 2021;doi:10.1056/NEJMe2116353.
Harter P, et al. N Engl J Med. 2021;doi:10.1056/NEJMoa2103294.