How Does Secondary Surgical Cytoreduction Compare With Chemotherapy for Recurrent Ovarian Cancer?
Posted: Monday, December 2, 2019
Although secondary surgical cytoreduction is widely practiced among women with recurrent epithelial ovarian, primary peritoneal, or fallopian tube cancer, it has not been tested in a phase III setting. Robert L. Coleman, MD, of The University of Texas MD Anderson Cancer Center, Houston, and colleagues shared their results of a phase III trial in The New England Journal of Medicine; secondary surgical cytoreduction does not appear to improve survival more than chemotherapy alone in this patient population.
“The hazard ratio for disease progression or death did not indicate that surgery plus chemotherapy was superior to chemotherapy alone,” they concluded.
The investigators randomly assigned 485 patients with recurrent ovarian cancer to secondary cytoreduction before chemotherapy (n = 240) or chemotherapy alone (n = 245). All eligible patients had received one previous therapy, had a platinum-free interval of at least 6 months, and had investigator-determined resectable disease. The median follow-up was 48.1 months.
The median overall survival was 50.6 months for the surgery arm and 64.7 months for the chemotherapy arm (P = .08). The adjusted hazard ratio for death (surgery vs. no surgery) was 1.29. Adjusting for the platinum-free interval and chemotherapy choice did not change the results. The median progression-free survival was 18.9 months for patients undergoing surgery and 16.2 months for those receiving chemotherapy alone. Surgical morbidity was 9% at 30 days, and a single patient died of postoperative complications. Although patient-reported quality of life significantly decreased after surgery, the outcomes did not differ between the two patient groups after recovery.
Disclosure: For full disclosures of the study authors, visit nejm.org.