Hello. I am Dr Maurie Markman from Cancer Treatment Centers of America in Philadelphia. I’d like to briefly discuss two abstracts presented at the recent 2017 American Society of Clinical Oncology (ASCO) Meeting in the gynecologic cancer session that specifically dealt with surgical issues. These abstracts and studies very much will inform future patient management, and it’s important to note them. Ultimately, of course, we will need to wait for the final reports and peer-reviewed publications.
LION Study: Lymphadenectomy in Ovarian Neoplasms
The first abstract was from a study called LION, Lymphadenectomy In Ovarian Neoplasms, a prospective, randomized AGO study group–led gynecologic cancer intergroup trial. This study looked at a question that has been relevant to the gynecologic cancer community, quite frankly, for decades. That is, what is the role of a complete lymphadenectomy performed in a setting where a surgeon has been able to already remove gross residual disease in a patient with advanced ovarian cancer? What is the advantage of now going in and trying to remove nonvisible microscopic cancer within lymph nodes or microscopic disease?
In this trial, patients were randomized to complete surgical cytoreduction versus a cytoreduction with lymphadenectomy. The bottom line was that the additional lymphadenectomy did not improve a survival outcome, suggesting its lack of utility, certainly, in most clinical settings. Of course, like other studies performed and presented in abstract form at an annual meeting like ASCO, we need to wait for the final peer-reviewed publication. I think this will be a very important study that will inform clinical practice.
Secondary Cytoreductive Surgery in Recurrent Ovarian Cancer
The second study looked at a different surgical question in ovarian cancer. This randomized controlled phase 3 AGO DESKTOP/ENGOT study evaluated the impact of secondary cytoreductive surgery in recurrent ovarian cancer. Patients were randomized to chemotherapy directly or surgery followed by chemotherapy. This is a very important question and this randomized trial was designed to ultimately address the utility of this approach.
This preliminary report demonstrated that women who underwent surgery followed by chemotherapy had an improvement in progression-free survival compared with patients who were randomized to chemotherapy only. It was a very interesting report, but as noted in a question from the audience, one might assume that in a patient who has had surgery—certainly surgery that removed all residual disease—it may simply take artificially longer for a CT scan, for example, to be able to demonstrate progression. The tumor may be growing, but you cannot see it, versus in a patient who already has macroscopic cancer and the cancer is growing, which would be seen more readily on a scan. Therefore, you may artificially assume that there is some improvement in progression, but in fact it’s really only because of the artifact of having much smaller–volume disease to observe. Ultimately, the results of this trial and the benefits will be determined by the impact on overall survival. The data on this point will be coming in the future.
Again, both of these trials were extremely well done and are extremely important for helping to inform the management of ovarian cancer. The investigators and the patients who agreed to participate are to be applauded for these two very important trials.
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