On the first day of the American Society of Clinical Oncology (ASCO) Annual Meeting (May 30, 2020), Helen MacKay, MBChB, BSc, MRCP, MD, department of medicine, University of Toronto, provided the context and implications of the final analysis of the AGO DESKTOP III study.
Dr MacKay began her presentation by posing some the current challenges for improving survival for women with recurrent platinum-sensitive epithelial ovarian cancer, including questions of whether there is a survival benefit for secondary surgical “maximum effort” cytoreductive surgery at the time of first recurrence in women with this diagnosis.
“The topic of secondary surgery is not a new one,” she stated, noting its presence in NCCN guidelines for women with complete remission and relapsed disease 6 months after completing prior chemotherapy.
The DESKTOP III study considered women with a disease-free interval of greater than 6 months as well as good performance status (ECOG = 0), no residual status after primary surgery, and no or small volume ascites (< 500 ml). These selection criteria were developed as a result of the earlier DESKTOP studies.
As a result, 407 patients were included from 80 centers across 12 countries. Those randomized to the experimental arm (n = 206) underwent cytoreductive surgery with maximum effort for complete resection followed by platinum-based adjuvant therapy. Patients not receiving cytoreductive surgery (n = 201) were given immediate platinum-based therapy.
“Selection criteria were effective, with 74.2% of women able to undergo a complete gross resection,” Dr MacKay said, adding that there was low post-operative morbidity, which may be an important consideration for women considering this approach.
At the ASCO meeting in 2018, the initial analysis of the DESKTOP study showed an improvement in progression-free survival of 5.6 months and a lengthening of time to third-line chemotherapy in patients receiving cytoreductive surgery. The final analysis of the DESKIPT III study shows that this translated into a 7.7-month improvement in median overall survival and a significant reduction in the hazard for death of 25%.
“This is the first trial to demonstrate an overall survival benefit of surgery in recurrent, platinum-sensitive disease,” Dr MacKay posited. However, this treatment approach will require careful discussion with the individual women and should really be based on the probability of being able to undergo a complete resection, she added.
In her concluding remarks, Dr MacKay said she does not believe that the surgical debate is over. “Perhaps there is further optimization to be achieved with extending criteria, and I know that in certain centers this is already being done,” she explained.
Additionally, she highlighted the need to better understand the biology of patients undergoing surgery, as well as the impact of adjuvant treatments.—Zachary Bessette
