Dr Manning-Geist on Secondary Cytoreductive Surgery in Ovarian Cancer

Beryl Manning-Geist, MD, gynecologic oncology fellow, Memorial Sloan Kettering Cancer Center, discusses findings from a study evaluating the effects of primary treatment modality on secondary cytoreduction outcomes in patients with high-grade ovarian cancer.

Dr Manning-Geist on Prior Research Investigating Secondary Cytoreductive Surgery in Ovarian Cancer

Three large, randomized clinical trials have evaluated the efficacy of secondary cytoreductive surgery in patients with epithelial ovarian cancer: DESKTOP III (NCT01166737), SOC1 (NCT01611766), and GOG 213 (NCT00565851), Manning-Geist says. In DESKTOP III and SOC1, 0% and 13% of patients, respectively, had disease recurrence following upfront neoadjuvant chemotherapy plus interval debulking surgery, and the rest of the patients recurred after primary cytoreduction. These trials aimed to determine whether patients with ovarian cancer should receive chemotherapy or surgery for disease recurrence, Manning-Geist explains. As the use of neoadjuvant chemotherapy for ovarian cancer is increasing across the world, these trials indicate the benefits of secondary cytoreduction in an ovarian cancer patient population that has had primary debulking surgery in the upfront setting, Manning-Geist notes.

However, the benefits of secondary cytoreduction in patients who received upfront neoadjuvant chemotherapy and interval debulking surgery are less documented, Manning-Geist says. An evaluation of the efficacy of secondary cytoreduction aimed to clarify this treatment benefit in patients with potentially resectable recurrent disease that was initially treated with frontline neoadjuvant chemotherapy.

Dr Manning-Geist on the Effects of Neoadjuvant Chemotherapy on PFS Outcomes After Secondary Surgery

This retrospective study included patients with ovarian cancer treated at Memorial Sloan Kettering Cancer Center who received secondary cytoreduction. These patients were stratified by frontline treatment, either primary debulking surgery or interval debulking surgery, Manning-Geist describes. These findings showed that patients in both groups had similar times to second progression (PFS2) after cytoreductive surgery, regardless of how they were diagnosed or treated prior to secondary surgery, Manning-Geist emphasizes. The median PFS2 was 17 months in patients who received prior interval debulking surgery vs 20 months in those who received prior primary debulking surgery.

These findings indicate that secondary cytoreductive surgery can lead to complete gross resections in patients with recurrent ovarian cancer regardless of their prior treatment, Manning-Geist concludes.

Editor’s Note: Dr Manning-Geist reports no financial disclosures.