The DESKTOPIII trial in platinum-sensitive ovarian cancer

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Published: 24 Jan 2018
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Prof Sean Kehoe - University of Birmingham, Birmingham, UK

Prof Kehoe speaks with ecancer at the 10th BGICC in Cairo about the DESKTOPIII trial comparing the efficacy of additional tumour debulking surgery versus chemotherapy alone for recurrent platinum-sensitive ovarian cancer.

With survival endpoints not yet reached, he describes the improved survival and quality of life seen in the trial as encouraging for relapsed patients.

Prof Kehoe also discussed the fallopian tube as a site of primary lesions here.

The DESKTOPIII trial was run by Andreas Du Bois, who is a Professor, and the AGO, which is the Germanic, if you like, Oncology Group, looking at the role of surgery in women with relapsed ovarian cancer who have what we call platinum sensitive relapse. In other words the actual time of relapse itself had to be a certain duration from primary therapy. There were quite a lot of centres involved in this looking at normal treatment, which was at relapse give chemotherapy, but the other arm, the other randomisation arm, was adding surgery to the chemotherapy to try and remove all of the disease. It was a primary endpoint of overall survival and over 400 women were randomised. To date the overall survival, primary endpoint, is awaited so we do have to be a little bit careful but what has been shown already is that the progression free survival and the treatment free interval with surgery were both improved. In view of that, whilst we have to wait for primary outcomes, it's looking as if possibly in the future that surgery will have an important role in these types of women in the relapsed setting. It's important to stress the fact that these are selected women, this is not every single woman who will relapse at any time. So there's careful selection of these patients, quite correctly.
There are no real age boundaries at all, most of these patients have advanced disease, understandably because the vast majority of those do relapse, but the average age is 62, the median age of the patients, which is very much an ovarian cancer population even at primary presentation.

Do you think that immunotherapies will be used alongside surgery?

Yes, I think in fact that will happen and immunotherapy already targeting PD-L1 is ongoing presently in early phase trials in ovarian cancer. So we are cognisant of the fact of the importance of immunotherapies. We know in advanced ovarian cancer, for example, the greater the number of T-cells within the tumour relates to prognosis. So there is a great interest in that and an evolution, if you like, very much of immunotherapy being the thing at the moment. So that will come in in combination with surgery because surgery and chemotherapy together in all settings, if you like, of ovarian cancer, but definitely in the primary setting, are quite an important combination.

When can we expect the final outcomes from the study?

I don't have that information at the moment. We're quite surprised, really, at the fact that the events and that the overall survival is actually so good. But I would have thought at a guestimate we're probably talking about another six, maybe twelve months maximum for the full publication to come out. But that's very much a guestimate because everybody is waiting to see what happens. So it was an unexpected fact that people actually were doing so well. But that's good news for patients.

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