181MO - Secondary cytoreduction in platinum-sensitive relapsed ovarian cancer: An individual patient level meta-analysis

Background

The role of secondary cytoreduction in recurrent ovarian cancer has not been clearly defined. We aim to synthesize the efficacy of secondary cytoreduction in platinum-sensitive relapsed ovarian cancer patients.

Methods

Following databases were searched; PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov, from inception to November 2021. Randomized trials evaluating secondary cytoreduction followed by chemotherapy versus chemotherapy alone in patients with platinum-sensitive relapsed epithelial ovarian cancer, were selected. Individual patient data (IPD) for overall survival (OS) and progression-free survival (PFS) was manually extracted from published survival curves of randomized controlled trials (RCT), for whole study populations and subgroups based on completeness of surgical resection and bevacizumab use, using WebPlotDigitizer software. OS and PFS curves for each study and combined population were reconstructed from extracted IPD. The main outcome measures were: OS and PFS in the whole study population and OS in subgroups based on completeness of resection.

Results

Three RCTs with 1249 patients were included, of which 427 achieved complete resection. In IPD analysis of the whole study population, with 1249 patients and 930 events, PFS was significantly longer with surgery followed by chemotherapy versus chemotherapy alone (median 18.3 vs 14.4 months, respectively, HR 0.70; 95%CI 0.62 to 0.80; P<0.001). There was no difference in OS between surgery and no surgery group (median 52.8 vs 52.1 months, respectively, HR 0.94; 95%CI 0.80 to 1.11; P = 0.5). In IPD subgroup analyses), OS was significantly longer in the complete cytoreduction subgroup compared to no surgery group (median 62.0 vs 52.1 months, respectively, HR 0.70, 95% CI 0.57 to 0.92; p <0.001) while OS was worse in the incomplete cytoreduction subgroup compared to no surgery (median 34.2 vs 52.1 months, respectively, HR 1.72, 95% CI 1.38 to 2.14; p <0.001).

Conclusions

In women with platinum-sensitive relapsed ovarian cancer, secondary cytoreduction followed by chemotherapy was associated with longer survival among patients who underwent complete cytoreduction.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.