Secondary Debulking Surgery Improves PFS in Recurrent Ovarian Cancer

Platinum-sensitive ovarian cancer patients with a positive predictive AGO score who undergo a secondary debulking surgery after relapse on platinum chemotherapy experience longer progression-free survival.

CHICAGO-Patients with a positive predictive AGO score who undergo a secondary debulking surgery for platinum-sensitive ovarian cancer first relapsing after at least 6 months since platinum chemotherapy experience longer progression-free survival (PFS), according to research findings from the randomized, controlled phase III AGO DESKTOP I trial (abstract 5501) presented at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting, held June 2-6.

Surgery in patients with AGO score-positive, platinum-sensitive, recurrent ovarian cancer resulted in a PFS advantage of 5.6 months, reported lead study author Andreas Du Bois, MD, PhD, of AGO and Kliniken Essen Mitte, in Essen, Germany.

These results are comparable with findings from previously reported phase III trials of second-line therapy for platinum-sensitive, recurrent ovarian cancer, he said. Previously, the evidence base for secondary cytoreductive surgery for recurring ovarian cancer was limited to nonrandomized and retrospective studies.

AGO DESKTOP I employed a predictive AGO score to identify patients who will have complete tumor resection in secondary surgery, composed of an Eastern Cooperative Oncology Group performance score of 0, complete resection during first-line treatment, and ascites totaling less than 500 mL.

Overall, among 407 patients, the 204 who were randomly assigned to undergo cytoreduction surgery had a median PFS of 19.6 months vs 14.0 months among the 203 patients who did not receive surgery (hazard ratio, 0.66; 95% CI: 0.52–0.83; P < .001).

Time to third-line therapy was also significantly longer among patients who underwent surgery than those who did not, he noted (median, 21.0 vs 13.9 months; P < .001).

“A benefit of surgery was exclusively seen in patients with complete resection, indicating the importance of selecting both the right center, with capability to achieve complete resection in the majority of patients, and the right patients based here on AGO score,” Du Bois concluded.

Complete resection was associated with improved PFS compared with residual tumor after surgery (median PFS, 21.7 vs 13.7 months; P < .0001).