Debate 20B - Should All Patients with Platinum-sensitive Recurrent Ovarian Cancer be Considered for Secondary Cytoreduction prior to Receiving Second-line Platinum Chemotherapy?

Summary

Ardent support of secondary cytoreductive surgery as a strategy in the treatment paradigm for patients with recurrent ovarian cancer has been levied for decades, largely by analogy to primary cytoreduction [1]. The primary rationale follows that removal of as much tumor as possible augments the effectiveness of subsequent chemotherapy and may enhance a more favorable tumor microenvironment for natural immune surveillance. However, the merit of this, as with any intervention, should be addressed in randomized clinical trials, if possible, to control bias, and compared to appropriate reference treatment assessing clinically relevant endpoints. This “tried and true” approach has been the foundation upon which current treatment standards have been defined. In the setting of recurrent ovarian cancer, a prolific expansion in efficacious therapies has been witnessed, challenging clinical trial endpoints, such as overall survival (OS), which may not be reached years after an index intervention [2].