2020 Top Stories in Oncology: DESKTOP III: Surgery for Recurrent Ovarian Cancer
The blockbuster study of this year for ovarian cancer was indisputably DESKTOP III.1 Before ASCO 2020, the role of surgery for recurrent ovarian cancer had not been defined by prospectively randomized surgical trials. DESKTOP III changed the story.
Three consecutive AGO studies established the body of evidence over time.
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DESKTOP I developed a hypothesis for a predictive score to identify patients who had a complete resection during secondary cytoreductive surgery.2 This AGO score consisted of 1) good performance status (ECOG 0), 2) complete resection during first-line therapy, and 3) ascites less than 500 mL.
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DESKTOP II evaluated this score in a prospective multicenter trial in patients with a platinum-free interval of 6+ months and confirmed its predictive value.3 Overall, 51% of patients had a positive AGO score, and it could predict with 95% probability complete resection in more than 2 of 3 patients.
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DESKTOP III was the first prospectively randomized trial showing an overall survival (OS) benefit of debulking surgery in recurrent ovarian cancer.1 Cytoreductive surgery for patients with a platinum-free interval of >6 months and selected by the AGO score significantly prolonged both OS and progression-free survival. The OS benefit of more than 1 year was highest and exclusively seen in the cohort with complete resection, indicating the importance of a thorough selection process.
An updated analysis presented at ESMO 2020 regarding time to first subsequent therapy (TFST) demonstrated that surgery with complete resection was also superior to no or incomplete surgery and that patients with incomplete surgery had the same prognosis regarding TFST compared with patients treated with chemotherapy only.4
Conclusion: For recurrent ovarian cancer, the right patient receiving the right therapy in the right center may gain more than 1 year of OS.
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Additional Info
- Du Bois A, Sehouli J, Vergote I, et al. Randomized phase III study to evaluate the impact of secondary cytoreductive surgery in recurrent ovarian cancer: final analysis of AGO DESKTOP III/ENGOT-ov20. J Clin Oncol. 2020;38(15_suppl):6000.
- Harter P, du Bois A, Hahmann M, et al. Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Committee; AGO Ovarian Cancer Study Group. Surgery in recurrent ovarian cancer: the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR trial. Ann Surg Oncol. 2006;13(12):1702-1710.
- Harter P, Sehouli J, Reuss A, et al. Prospective validation study of a predictive score for operability of recurrent ovarian cancer: the Multicenter Intergroup Study DESKTOP II. A project of the AGO Kommission OVAR, AGO Study Group, NOGGO, AGO-Austria, and MITO. Int J Gynecol Cancer. 2011;21(2):289-295.
- Lecuru F, du Bois A, Sehouli J, et al. AGO DESKTOP III/ENGOT OV20: impact of surgical characteristics and time to first subsequent therapy (TFST). Ann Oncol. 2020;31(suppl 4):S617.
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