816MO - AGO DESKTOP III/ENGOT OV20: Impact of surgical characteristics and time to first subsequent therapy (TFST)

Background

DESKTOP III has shown a significant benefit regarding PFS and OS in favor of patients with secondary cytoreductive surgery compared to chemotherapy alone. This benefit seems to be limited to patients with complete cytoreduction. The reason for limited outcome in patients with suboptimal surgery could be residual disease, peri-operative characteristics or tumor biology. While TFST is an often-used parameter in oncologic trials, its role in surgical trials is not defined.

Methods

Analysis of characteristics of surgery and systemic treatment, surgical complications, and tumor biology as predictive and prognostic factors. For this analysis, patients were splitted into 3 subgroups: (1) Control arm vs (2) surgical arm but no complete resection vs (3) surgical arm and complete resection.

Results

Group 1 included 201 patients, group 2 included 65 of (46 with documented tumor residuals after surgery, 16 without surgery, 3 without data about residuals) and group 3 included 141 patients. The use of platinum-based chemotherapy was 90% in group 1 vs 83.1% in group 2 and 91.5% in group 3. The use of bevacizumab was about 23% and PARP-inhibitors in < 10% in all groups. Median duration of surgery was 204 minutes in group 2 and 230 minutes in group 3. Time from randomization to start of systemic therapy was 15 days in group 1 vs 51 and 53 days in group 2 and 3, respectively. The re-laparotomy rate was about 3% in group 2 and 3. 30-day mortality rate was 0 in all arms. TFST in the surgical arm was significantly longer compared to the non-surgical arm (16.0 vs 21.3 months; p<0.001). TFST in group 1 vs 2 vs 3 was 16.0 vs 16.1 vs 26.3 months, respectively (p<0.001).

Conclusions

Suboptimal surgery seems to have similar burden as complete resection. Therefore, preoperative selection in an experienced Gynecologic Oncology center is indicated to avoid suboptimal debulking. TFST is prolonged substantially by complete resection.

Clinical trial identification

NCT01166737.

Editorial acknowledgement

Legal entity responsible for the study

AGO Study Group.

Funding

ARCAGY-GINECO.

Disclosure

F. Lecuru: Advisory/Consultancy, Travel/Accommodation/Expenses: AstraZeneca; Advisory/Consultancy, Travel/Accommodation/Expenses: Tesaro; Advisory/Consultancy: Clovis Oncology. A. du Bois: Advisory/Consultancy: AstraZeneca; Advisory/Consultancy: Roche/Genentech; Advisory/Consultancy: Genmab; Advisory/Consultancy: Clovis Oncology; Advisory/Consultancy: Tesaro; Advisory/Consultancy: BioCad; Advisory/Consultancy: Ingress Health; Advisory/Consultancy: TLC Biopharmaceuticals. J. Sehouli: Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: AstraZeneca; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Clovis Oncology; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: PharmaMar; Advisory/Consultancy, Research grant/Funding (institution): Merck; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution): Pfizer; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Tesaro; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: MSD Oncology; Advisory/Consultancy: Lilly; Advisory/Consultancy: Novocure; Travel/Accommodation/Expenses: Olympus; Honoraria (self), Advisory/Consultancy: Johnson & Johnson; Travel/Accommodation/Expenses: Roche Pharma AG; Honoraria (self): Eisai; Honoraria (self): Olympus Medical Systems; Honoraria (self): Teva; Honoraria (self): GlaxoSmithKline; Honoraria (self), Research grant/Funding (institution): Bayer; Research grant/Funding (institution): Roche. I.B. Vergote: Advisory/Consultancy: PharmaMar; Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Roche; Advisory/Consultancy: Merck Sharp & Dohme; Advisory/Consultancy, Research grant/Funding (institution): Genmab; Advisory/Consultancy: Millennium; Advisory/Consultancy: Clovis Oncology; Advisory/Consultancy: Immunogen; Advisory/Consultancy, Travel/Accommodation/Expenses: Tesaro; Advisory/Consultancy, Research grant/Funding (institution): Oncoinvent; Advisory/Consultancy: Sotio; Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Amgen; Advisory/Consultancy, Travel/Accommodation/Expenses: AstraZeneca; Advisory/Consultancy: Carrick Therapeutics; Advisory/Consultancy: Debiopharm Group; Advisory/Consultancy: GlaxoSmithKline; Advisory/Consultancy: Medical University of Vienna; Advisory/Consultancy: Octimet; Travel/Accommodation/Expenses: MSD/Merck. G. Ferron: Advisory/Consultancy: Olympus; Advisory/Consultancy, Travel/Accommodation/Expenses: AstraZeneca; Advisory/Consultancy: GlaxoSmithKline/Tesaro; Travel/Accommodation/Expenses: Roche Pharma AG; Travel/Accommodation/Expenses: PharmaMar. W. Meier: Honoraria (self): AstraZeneca; Honoraria (self): Tesaro; Honoraria (self): Roche. S. Greggi: Advisory/Consultancy: AstraZeneca; Advisory/Consultancy, Travel/Accommodation/Expenses: Roche. F. Selle: Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Roche; Honoraria (self), Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: AstraZeneca; Honoraria (self), Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Tesaro; Honoraria (self), Speaker Bureau/Expert testimony: GlaxoSmithKline; Honoraria (self), Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: PharmaMar; Honoraria (self), Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: MSD; Honoraria (self): Clovis Oncology. C. Pomel: Honoraria (self), Advisory/Consultancy: AstraZeneca; Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Roche; Honoraria (self): GlaxoSmithKline; Honoraria (self), Advisory/Consultancy: Clovis Oncology. E.H. Avall-Lundqvist: Advisory/Consultancy: AstraZeneca; Advisory/Consultancy: Tesaro; Advisory/Consultancy: Clovis Oncology; Advisory/Consultancy: Genmab; Honoraria (self): Roche. J. Ponce: Advisory/Consultancy: Medtronic; Advisory/Consultancy: Abex; Advisory/Consultancy: KCI. F. Raspagliesi: Advisory/Consultancy: Tesaro-GSK; Travel/Accommodation/Expenses: Roche. G-M. Sadaf: Travel/Accommodation/Expenses: AstraZeneca; Travel/Accommodation/Expenses: Johnson & Johnson. A. Reinthaller: Honoraria (self), Travel/Accommodation/Expenses: Roche; Honoraria (self), Travel/Accommodation/Expenses: PharmaMar; Honoraria (self), Travel/Accommodation/Expenses: AstraZeneca; Honoraria (self), Travel/Accommodation/Expenses: Tesaro; Honoraria (self): Novartis; Honoraria (self): GlaxoSmithKline; Honoraria (self): Amgen. P. Harter: Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution): AstraZeneca; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution): Roche; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution): Tesaro; Advisory/Consultancy: Merck; Honoraria (self): Clovis Oncology; Honoraria (self): Stryker; Honoraria (self): MSD Oncology; Honoraria (self): Zai Lab; Honoraria (self): Lilly; Honoraria (self): Sotio; Research grant/Funding (institution): Genmab. All other authors have declared no conflicts of interest.