Should we or should we not? Secondary debulking in ovarian cancer

Mené en Chine auprès de 357 patientes atteintes d'un cancer de l'ovaire récidivant et sensible aux sels de platine, cet essai multicentrique de phase III évalue l'efficacité, du point de vue de la survie sans progression et de la survie globale, et la sécurité d'une seconde cytoréduction suivie d'une chimiothérapie par rapport à une chimiothérapie seule

Résumé en anglais

In The Lancet Oncology, Tingyan Shi and colleagues report their findings from the SOC-1 trial, one of three randomised phase 3 trials of secondary debulking followed by platinum-based chemotherapy versus chemotherapy alone in patients with their first recurrence of platinum-sensitive ovarian cancer. Previously, DESKTOP III and GOG-0213 reported results of this treatment strategy in the same population. Similar to DESKTOP III, objective eligibility criteria were used to determine likelihood of surgical resectability. In this current trial, Shi and colleagues used the iMODEL score (a compilation of International Federation of Gynecology and Obstetrics stage, residual disease at primary debulking, length of platinum-free interval, European Cooperative Oncology Group [ECOG] performance status, cancer antigen 125 level at recurrence, and presence of ascites) and a PET-CT. The AGO criteria used in the DESKTOP III trial were an ECOG performance status of 0, 500 mL volume of ascites or less, and complete cytoreduction in primary surgery. 3
The GOG-0213 trial did not use objective criteria to determine likelihood of resection, but rather likelihood of resection was by investigator discretion. However, all three trials achieved a high rate of complete gross resection: 77% in SOC-1, 75% DESKTOP III, and 67% in GOG-0213, with acceptable morbidity.