Surgery in Recurrent Ovarian Cancer: The Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR Trial

Harter, Philipp; Bois, Andreas du; Hahmann, Maik; Hasenburg, Annette; Burges, Alexander; Loibl, Sibylle; Gropp, M.; Huober, Jens; Fink, Daniel; Schröder, Willibald; Muenstedt, Karsten; Schmalfeldt, Barbara; Emons, G.; Pfisterer, Jacobus; Wollschlaeger, K.; Meerpohl, Hans-Gerd; Breitbach, G. P.; Berno, Tamara; Sehouli, Jalid

doi:10.1245/s10434-006-9058-0

Cited by 375 publications

(239 citation statements)

References 27 publications

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“…A combination of PS, early FIGO stage initially or no residual tumor after first surgery, and absence of ascites could predict complete resection in 79 % of patients. [21] The DESKTOP 2 study prospectively analyzed the predictive value of 3 of these criteria (complete resection at first surgery, good performance status, and absence of ascites and found that when all 3 are met complete cytoreduction can be achieved in 79 % of the patients with a morbidity of 11 %. [22] These criteria exclude a subgroup of patients who never had surgery by a gynecologic oncologist/ surgical oncologist and hence have had an incomplete CRS.…”

Section: For Recurrent Ovarian Cancermentioning

confidence: 99%

The role of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Ovarian Cancer: A Review

Bhatt

Gléhen

2016

Indian J Surg Oncol

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Ovarian cancer is one of the leading causes of cancer related deaths in women worldwide. It is usually diagnosed in an advanced stage (Stages III and IV) when peritoneal cancer spread has already occurred. The standard treatment comprises of surgery to remove all macroscopic disease followed by systemic chemotherapy. Despite all efforts, it recurs in over 75 % of the cases, most of these recurrences being confined to the peritoneal cavity. Recurrent ovarian cancer has a poor long term outcome and is generally treated with multiple lines of systemic chemotherapy and targeted therapy. The propensity of ovarian cancer to remain confined to the peritoneal cavity warrants an aggressive locoregional approach. The combined treatment comprising of cytoreductive surgery (CRS) that removes all macroscopic disease and HIPEC (Hyperthermic Intraperitoneal Chemotherapy) has been effective in providing long term survival in selected patients with peritoneal metastases of gastrointestinal origin. Intraperitoneal chemotherapy used as adjuvant therapy has shown a survival benefit in ovarian cancer. This has prompted the use of CRS and HIPEC in the management of ovarian cancer as a part of first line therapy and second line therapy for recurrent disease. This article reviews the current literature and evidence for the use of HIPEC in ovarian cancer.

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Section: For Recurrent Ovarian Cancermentioning

confidence: 99%

The role of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Ovarian Cancer: A Review

Bhatt

Gléhen

2016

Indian J Surg Oncol

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“…Other key eligibility criteria included Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 23 ; adequate bone marrow, coagulation, and renal (creatinine 1.5 3 institutional upper limit of normal) and hepatic function; signed informed consent; and deemed resectable to no visible residual disease by the investigator based on selection criteria for secondary cytoreductive surgery. [24][25][26] Patients were ineligible if they met any of the following exclusion criteria: pre-existing neuropathy (National Cancer Institute Common Toxicity Criteria for Adverse Events [NCI-CTCAE] version 3.0) grade >1; known platinum allergy; borderline histology; and other serious disabling diseases that would contraindicate secondary cytoreductive surgery followed by postoperative platinum-based IV chemotherapy.…”

Section: Eligibility Criteriamentioning

confidence: 99%

HIPEC ROC I: A phase i study of cisplatin administered as hyperthermic intraoperative intraperitoneal chemoperfusion followed by postoperative intravenous platinum‐based chemotherapy in patients with platinum‐sensitive recurrent epithelial ovarian cancer

Zivanovic

Abramian

Kullmann

et al. 2014

Intl Journal of Cancer

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This phase I study tested the safety, feasibility, pharmacokinetics and pharmacodynamics of cisplatin administered as hyperthermic intraoperative intraperitoneal chemoperfusion (HIPEC) in patients with platinum-sensitive recurrent epithelial ovarian cancer (EOC) undergoing secondary cytoreductive surgery followed by postoperative platinum-based intravenous chemotherapy. Twelve patients with operable, recurrent platinum-sensitive EOC (recurrence !6 months after first-line therapy) were included according to the classical 313 dose-escalation design at three dose levels-60, 80 and 100 mg=m 2 . After surgical cytoreduction, a single dose of cisplatin was administered via HIPEC for 90 min at 41-43 C. Postoperatively, all patients were treated with standard intravenous platinum-based combination chemotherapy. One of six patients experienced a dose-limiting toxicity (grade 3 renal toxicity) at a dose of 100 mg=m 2 . The remaining five patients treated with 100 mg=m 2 tolerated their treatment well. The recommended phase II dose was established at 100 mg=m 2 . The mean peritoneal-to-plasma AUC ratio was 19Á5 at the highest dose level. Cisplatin-induced DNA adducts were confirmed in tumor samples. Common postoperative grade 1-3 toxicities included fatigue, postoperative pain, nausea, and surgical site infection. The ability to administer standard intravenous platinum-based chemotherapy after HIPEC was uncompromised. Cisplatin administered as HIPEC at a dose of 100 mg=m 2 has an acceptable safety profile in selected patients undergoing secondary cytoreductive surgery for platinumsensitive recurrent EOC. Favorable pharmacokinetic and pharmacodynamic properties of HIPEC with cisplatin were confirmed at all dose levels, especially at 100 mg=m 2 . The results are encouraging to determine the efficacy of HIPEC as a complementary treatment in patients with EOC.

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“…However, the criteria for SDS candidacy have not fully established; therefore, the benefit of surgery for patients with relapsed ovarian cancer may be limited (13). Recently, selection criteria for operable patients with recurrent ovarian cancer were suggested by the DESKTOP trial: i) Good PS, ii) no or small volume of ascites at recurrence, and iii) no gross residual disease after primary surgery (14). Another study suggested that the predictive factors for complete resection at SDS included FIGO stage, complete primary surgery, PFI, PS, CA125 value at recurrence and ascites at recurrence (15).…”

Section: Long-term Short-term Survivors N (%) Survivors N (%) -----mentioning

confidence: 99%

Factors favouring long-term survival following recurrence in ovarian cancer

Soyama

Takano

Miyamoto

et al. 2017

Molecular and Clinical Oncology

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Abstract. The aim of the present study was to identify clinicopathological factors in long-term survivors following ovarian cancer recurrence. The patients who achieved longer survival after recurrence (n=18) and those who succumbed to the disease earlier (n=47) were identified and analyzed. There were no significant differences in age, performance status, stage distribution or histology between the two groups. Additionally, no significant difference was observed in progression-free survival after primary therapy. Multivariate analyses revealed that the predictive factors for long-term survival were i) secondary debulking surgery (OR=13.3; 95% CI: 1.39-226.7), ii) favourable response rate of second-line chemotherapy (OR=46.5; 95% CI: 1.84-313-4), and iii) ≥3 regimens after first recurrence (OR=9.01; 95% CI: 1.28-117.7). This study revealed that prolonged post-progression survival was associated with post-recurrence treatment. Therefore, appropriate selection of secondary debulking surgery and better chemotherapeutic response may lead to prolonged post-progression survival in recurrent ovarian cancer patients.

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Surgery in Recurrent Ovarian Cancer: The Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR Trial

Cited by 375 publications

References 27 publications

The role of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Ovarian Cancer: A Review

The role of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Ovarian Cancer: A Review

HIPEC ROC I: A phase i study of cisplatin administered as hyperthermic intraoperative intraperitoneal chemoperfusion followed by postoperative intravenous platinum‐based chemotherapy in patients with platinum‐sensitive recurrent epithelial ovarian cancer

Factors favouring long-term survival following recurrence in ovarian cancer

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