Second surgery for many ovarian cancers found ineffective

(Reuters Health) – Going back into the operating room for surgery to help a woman whose ovarian cancer has reappeared may not help her live longer – instead, it might shorten her life, according to an international study of 485 women.

“I do think this study will decrease the number” of such surgeries that now appear to be unnecessary for many women, said Dr. Robert Coleman of the University of Texas M.D. Anderson Cancer Center in Houston, Texas, lead author of the study published in the New England Journal of Medicine.

The operations are currently considered standard medical care. But the new findings suggest that women who get chemotherapy alone if their tumor reappears do as well or better than women who received surgery before their chemotherapy.

The results only apply to women whose tumors are sensitive to platinum-based drugs.

After a median follow-up period of 48.1 months, median overall survival was 50.6 months for women with recurrent ovarian cancer who got surgery and chemotherapy and 64.7 months for those who got only chemotherapy.

That corresponded to a 29% increase in the death rate for the surgery recipients.

About 22,500 women in the U.S. develop ovarian cancer each year, according to the American Cancer Society. But more than 80% of women have their disease recur, the 10-year survival rate is below 15%, and roughly 14,000 are expected to die from their tumors. Roughly half of affected women have platinum-sensitive tumors. About one quarter of patients are candidates for secondary surgery if their tumor recurs.

The trial, known as GOG-0213, ended early when preliminary results showed that surgery was not helping. The volunteers had recurrent epithelial ovarian, primary peritoneal, or Fallopian-tube cancer.

Coleman told Reuters Health in a phone interview that the findings were surprising, but the effectiveness of secondary surgery had not been tested, and the results probably reflect the fact that chemotherapy for ovarian cancer has improved significantly.

The women in the trial “ended up living three times longer than when we started the trial,” said Coleman, who is executive director of cancer network research at M.D. Anderson.

Sixty-seven percent of the patients in the surgery group survived for three years versus 74% who only got chemotherapy.

“Patient-reported quality of life decreased significantly after surgery but did not differ significantly between the two groups after recovery,” the study team writes. The two groups reached parity on the quality of life measure by the six-week mark.

Coleman said M.D. Anderson and other cancer centers have stopped doing routine secondary surgery in the wake of the findings, but it may take time for other medical centers to follow suit.

“There are definitely doctors out where who feel that, even though the trial did not show a benefit, in their hands and in their specific patients, there’s a benefit, and a lot of patients would want it,” he said. “Most people, when they see cancer, they want it out.”

SOURCE: bit.ly/33CobKG The New England Journal of Medicine, online November 13, 2019.

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