Role of cytoreductive surgery for the second ovarian cancer relapse in patients previously treated with chemotherapy alone at first relapse: A subanalysis of the DESKTOP III trial.

person Jalid Sehouli Charité– Medical University of Berlin, Berlin, Germany info_outline Jalid Sehouli, Christina Fotopoulou, Ignace Vergote, Alexander Reuss, Gwenael Ferron, Werner Meier, Stefano Greggi, Berit J. Mosgaard, Frederic Selle, Frederic Guyon, Christophe Pomel, Fabrice Lecuru, Rongyu Zang, Kristina Hellmann, Jae-Weon Kim, Margarita Romeo, Francesco Raspagliesi, Brynhildur Eyjólfsdóttir, Andreas Du Bois, Philipp Harter

Authors person Jalid Sehouli Charité– Medical University of Berlin, Berlin, Germany info_outline Jalid Sehouli, Christina Fotopoulou, Ignace Vergote, Alexander Reuss, Gwenael Ferron, Werner Meier, Stefano Greggi, Berit J. Mosgaard, Frederic Selle, Frederic Guyon, Christophe Pomel, Fabrice Lecuru, Rongyu Zang, Kristina Hellmann, Jae-Weon Kim, Margarita Romeo, Francesco Raspagliesi, Brynhildur Eyjólfsdóttir, Andreas Du Bois, Philipp Harter Organizations Charité– Medical University of Berlin, Berlin, Germany, Imperial College London, London, United Kingdom, BGOG and Department of Obstetrics and Gynaecology, University of Leuven, Leuven Cancer Institute, Leuven, Belgium, AGO Study Group & Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg, Germany, GINECO and Institut Claudius Regaud, Toulouse, France, AGO Study Group & University Hospital Duesseldorf, Duesseldorf, Germany, MITO & Gynecologic Oncology, Instituto Tumori Fondazione G. Pascale, Naples, Italy, NSGO & Copenhagen University Hospital, Copenhagen, Denmark, GINECO & Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France, GINECO & Institut Bergonie, Bordeaux, France, GINECO & Centre Jean Perrin, Clermont Ferrand, France, GINECO & Curie Institute, Paris, France, SGOG & Fudan University Zhongshan Hospital, Shanghai, China, NSGO & Karolinska University Hospital, Stockholm, Sweden, KGOG & Seoul National University, Seoul, South Korea, GEICO & Catalan Institute of Oncology, Badalona, Barcelona, Spain, MITO and Fondazione IRCCS Istituto Nazionale dei Tumori– Milano, S.C. Ginecologia Oncologica, Milan, Italy, NSGO & Oslo University Hospital, Oslo, Norway, AGO Study Group & Evang. Kliniken Essen-Mitte, Essen, Germany Abstract Disclosures Research Funding Other Background: The DESKTOP III trial has demonstrated a significant survival benefit in AGO-score positive patients who underwent complete cytoreduction at 1st relapse compared to those treated with chemotherapy alone. The question whether eligible patients who missed the opportunity of potentially life prolonging surgery at 1st relapse would benefit from surgery at the time of their second relapse, remains open. Methods: Patients randomized in the standard, non-surgical arm of the DESKTOP III trial who underwent cytoreductive surgery at a subsequent relapse at investigator’s discretion were separately analyzed. Results: The median progression-free survival (PFS) counted from randomization of 201 patients in the control arm of DESKTOP III was 14.0 months. 171 (85%) had progressive or relapsing disease and 32 of 171 (19%) underwent cytoreductive surgery. Patients’ median age at this subsequent surgery was 63 years (range: 46 – 78). Complete tumor resection was achieved in 19 patients (60%), while 5 (16%) had postoperative residual disease (n = 8 missing data). Sixteen patients (50%) commenced systemic treatment within 90 days from surgery, as documented. Thirty- and 90-day surgical mortality rates were 1 (3%) and 2 (6%), respectively. Within a postoperative median follow-up time of 43.8 months, 12 (38%) deaths were reported. Median overall survival after surgery (OS) was 54.0 months. One- and 2-year OS rates were 91% and 84%, respectively. Conclusions: Cytoreductive surgery for subsequent ovarian cancer relapse appears feasible and with low mortality in selected patients who received non-surgical treatment at 1st relapse despite a positive AGO-score. Surgery should be considered as an option in carefully selected patients also later in their journey within a specialized gynecological cancer setting. Clinical trial information: NCT01166737.