When patients with ovarian cancer develop recurrent disease, secondary surgical cytoreduction followed by platinum-based chemotherapy is a common treatment approach. However, the efficacy of this approach previously has not been verified in a prospective phase III trial. In an attempt to answer that question, the GOG-0213 trial compared secondary cytoreduction followed by chemotherapy to chemotherapy alone in 485 patients with recurrent ovarian cancer with a platinum-free interval of 6 months or more. Results from this study were published recently in The New England Journal of Medicine.
Complete resection was achieved in 67% of patients who underwent surgery. At a median follow-up of 48.1 months, there was a significant overall survival (OS) advantage for patients who did not receive surgery. Among patients who underwent surgery, the median OS was 50.6 months, compared to 64.7 months among patients who did not receive surgery (HR 1.72, P = .8). The median progression-free survival (PFS) was longer among patients who received surgery, but this difference was not statistically significant (18.9 months vs 16.2 months; HR 0.82). In the surgery group, surgical morbidity was 9% and one patient died from postoperative complications. Patients reported significant decrease in quality of life (QoL) immediately postsurgery, but this was transient and did not translate to a difference in QoL between the two treatment groups.
The investigators concluded that secondary surgical cytoreduction does not improve outcomes in patients with recurrent ovarian cancer and may cause harm, indicating that this treatment approach may not be appropriate for this patient population. In light of these data, current guidelines recommending secondary cytoreduction will need to be reconsidered. However, it will be important to identify factors prognostic for improved outcomes without surgery and optimal treatment approaches, including the role of targeted therapy, in patients who do not receive secondary cytoreduction. Several ongoing trials will address these questions.
Read more about this article on Medscape Medical News.
N Engl J Med. 2019 Nov 13. [Epub ahead of print.]