Gynecologic Oncology Publishes Practice Statement on SCR in Recurrent Ovarian Cancer

“Secondary cytoreductive surgery for recurrent ovarian cancer: An SGO clinical practice statement,” written by members of the SGO Clinical Practice Committee, has been published in the December 2021 edition of Gynecologic Oncology. This Practice Statement reviews the rationale, background, and contemporary clinical trials evaluating secondary cytoreduction (SCR) for patients with recurrent ovarian cancer and promotes informed decision-making and treatment planning for these patients. The authors found that the evidence is mixed as to whether SCR improves survival for patients with platinum-sensitive recurrent ovarian cancer. Surgeons are advised to consider all available data to guide treatment planning for these patients.

The authors compared the clinical trials for SCR in ovarian cancer–GOG-0213, DESKTOP III and SOCI-1.

“The one surprising finding was that patients who underwent secondary cytoreductive surgery (SCS) and had visible residual disease had worse outcomes than patients who did not have surgery,” said lead author Amer Karam, MD. “The benefit of surgery was only seen in patients who underwent complete macroscopic resection in 2/3 trials with one trial showing no improvement in outcomes when chemotherapy is followed by maintenance bevacizumab therapy.”

This is not the first time researchers have tried to determine whether or not SCR improved OS among patients with recurrent ovarian cancer. The Dutch SOCceR trial and EORTC-55963/LOROCSON were randomized controlled trials examining the utility of SCS in patients with recurrent ovarian cancer. Those trials were closed prematurely due to low accrual.

Dr. Karam noted that there are several ongoing trials looking at Heated Intraperitoneal Chemotherapy (HIPEC) at the time of secondary cytoreductive surgery. “One of these phase 2 trials conducted at Memorial Sloan Kettering Cancer Center failed to show superior outcomes with the addition of HIPEC,” he said. “An ongoing phase 2 trial from the Shanghai GOG is examining the utility of SCS followed by platinum-based chemotherapy and niraparib maintenance therapy.

“Careful patient selection is key as it seems to influence the likelihood of success for SCS,” Dr. Karam added. “The addition of maintenance therapy with bevacizumab or PARP inhibitors may dilute the utility of SCS.”