Impact of secondary cytoreductive surgery on survival in patients with platinum sensitive recurrent ovarian cancer: analysis of the CALYPSO trial.

Abstract

OBJECTIVE:

The role of secondary cytoreductive surgery (SCR) in platinum-sensitive recurrent ovarian cancer (ROC) remains controversial. The overall survival (OS) benefits for surgery reported in observational studies may be due to the selection of patients with better prognosis.

METHODS:

Using data from the CALYPSO trial, OS of patients who had SCR was compared to those treated with chemotherapy alone. Multivariate analyses were performed to adjust for prognostic factors. We also tested for an interaction between baseline prognostic groupings and the benefit of surgery.

RESULTS:

Of the 975 patients randomised in CALYPSO, 19% had SCR and 80% had chemotherapy alone. OS was longer for the SCR group than for chemotherapy alone (median, 49.9 vs. 29.7 months; adjusted hazard ratio (HR), 0.68; P = 0.004). For patients with SCR, the 3-year OS was 72% for those with no measurable disease, and 28% if residual tumour was larger than 5 cm. Patients with good prognostic features benefited the most from SCR (HR 0.43; P < 0.001). The benefit of SCR was less in patients with poorer prognostic features (test of trend P < 0.001).

CONCLUSION:

SCR was associated with improved OS in platinum-sensitive ROC, particularly in patients with favourable prognostic characteristics. However, these findings may be due to selection bias, and hence randomised trials are still essential.

• Authors: Chee Khoon Lee, Sarah Lord, Tami Grunewald, Val Gebski, Anne-Claire Hardy-Bessard, Jalid Sehouli, Kathrine Woie, Mark Heywood, Christian Schauer, Ignace Vergote, Giovanni Scambia, Annamaria Ferrero, Philipp Harter, Eric Pujade-Lauraine, Michael Friedlander
• Journal: Gynecologic oncology (Gynecol Oncol) Vol. 136 Issue 1 Pg. 18-24 (Jan 2015) ISSN: 1095-6859 [Electronic] United States
• PMID: 25281492 (Publication Type: Clinical Trial, Phase III, Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• liposomal doxorubicin
• Polyethylene Glycols
• Doxorubicin
• Carboplatin
• Paclitaxel

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Carboplatin (administration & dosage, adverse effects)
• Combined Modality Therapy
• Disease-Free Survival
• Doxorubicin (administration & dosage, adverse effects, analogs & derivatives)
• Female
• Humans
• Middle Aged
• Neoplasm Recurrence, Local (drug therapy, surgery)
• Ovarian Neoplasms (drug therapy, surgery)
• Paclitaxel (administration & dosage, adverse effects)
• Polyethylene Glycols (administration & dosage, adverse effects)
• Prognosis
• Survival Rate
• Young Adult