Takeaway
- In patients with platinum-sensitive recurrent ovarian cancer, secondary surgical cytoreduction followed by chemotherapy is feasible but does not extend survival vs chemotherapy alone.
Why this matters
- Secondary cytoreduction is widely performed, but there is limited supporting literature.
Study design
- Phase 3, multicenter, GOG-0213 study of 485 platinum-sensitive patients with recurrent epithelial ovarian, primary peritoneal, or fallopian tube cancer.
- Patients were randomly assigned 1:1 to either undergo secondary surgical cytoreduction followed by platinum-based chemotherapy or platinum-based chemotherapy alone.
- Funding: National Cancer Institute.
Key results
- Median follow-up was 48.1 months.
- 67% of the patients who underwent surgery achieved complete gross resection.
- 84% of patients received concomitant and maintenance bevacizumab.
- No difference was observed in the surgery vs no-surgery group in:
- OS (median, 50.6 vs 64.7 months; HR, 1.29; P=.08); adjustment for chemotherapy regimen used, platinum-free interval, or previous bevacizumab use did not modify the OS.
- PFS (median, 18.9 vs 16.2 months; HR, 0.82; 95% CI, 0.66-1.01).
- Surgical morbidity was 9% at 30 days and 0.4% of patients died from postoperative complications.
- Patients undergoing surgery reported a significant decline immediately after secondary cytoreduction.
- QoL did not differ between groups at 6 and 15 weeks and at 6- and 12-month follow-ups.
Limitations
- Open-label design.
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