Robert L. Coleman, MD, on the Role of Surgery Moving Forward in Platinum-Sensitive, Recurrent Ovarian Cancer

Recent study results, presented at the 2020 ASCO Virtual Program, may question the role of secondary surgical cytoreduction in women platinum-sensitive, recurrent ovarian cancer.

In an interview with CancerNetwork, Robert L. Coleman, MD, chief scientific officer of US Oncology Network, discussed how results from the DESKTOP III and SOC1 may have changed how oncologists determine the appropriate treatment for patients.

Transcription:

We presented these data actually last year in 2019, and published them this year. And then this year, the reason it came back up was that the 2 other trials that we've been waiting on met maturity of their data, DESKTOP III and SOC1, and both were also reported. So, that’s what I reviewed.

To some extent, some confusion has been now put into the space again, because DESKTOP III essentially showed that it actually improved overall survival, which was their primary end point. And the 2 trials are actually fairly close in terms of how they enrolled patients and how well the patients did for surgery. In fact, if you actually look at the surgical arm, in DESKTOP III, and the surgical arm in GOG 213, they're almost completely overlapping, which means that the patients that we selected and the patients that they selected are relatively similar. They also had a very similar potential response to chemotherapy because they had the same kind of platinum-free interval. But the difference was the chemotherapy that was administered in GOG 213 had a lot of patients who received bevacizumab, about 85%. So, we think that maybe there's an importance in the type of therapy that a patient gets that may actually impact the decision as to whether or not to undergo surgery.

So if you're in a situation where bevacizumab (Avastin) is not a an appropriate advent to use with your chemotherapy or the patient has a risk factor for it, then there may be some impact for surgery in that setting. The question is though, is that both of these trials don't really assess the value of a PARP inhibitor, which again, that we have already shown, has dramatically improved the progression free survival, even more so than we saw with bevacizumab. But just as was also reported at ASCO, it also improves overall survival.

So again, we're back in the situation to say “Well, what's the contribution of surgery?” And so what I can say really is that if you're just going to give chemotherapy and that's it, then there may be a role for highly selective patients who could undergo surgery. I'll grant that because that's probably best addressed in DESKTOP III and SOC1. But SOC1 did not show an improvement in overall survival. So there's a little bit of a disconnect there, even though the data are still a little bit immature.

So the message to give to patients is that we're still working on it. What I would say is that contemporary management with active chemotherapy, whether it's good or bad, or part or even the combination of that time to come may actually continue to move the impact of surgery to the side, even with highly selected patients. That's just because the medical therapy is so good.

On the other hand, if there are no opportunities to get access to those kinds of drugs, then maybe there may be a role but in highly selective patients, and I keep emphasizing highly selected because the patients who were taken to surgery and did not get a good result did worse than if they had gotten chemo, so that's an important concept. What it does is it places the emphasis on patient selection and surgical skill.