The two main surgical studies that were presented in the oral gynae session in ASCO last month was a study, the GOG213 from Rob Coleman from MD Anderson, about the significance and survival benefit of patients who had recurrent surgery at the secondary debulking. What we knew so far from retrospective studies was that patients who are operated tumour-free at relapse had a longer survival compared to those who were not operated tumour-free. However, what we didn’t know is whether it’s the tumour biology that dictates everything, that makes the patients more operable and also live longer, or whether it’s the actual surgery that makes a difference.

There was a study presented last year from the German AGO, the DESKTOP trial, that showed a significant PFS prolongation from surgery with a median survival difference of six months in the favour of the surgical arm. However, the GOG213 could not confirm the data; there was no significant difference, neither in OS nor in PFS for the surgical arm. The difference in the GOG 213 compared to the DESKTOP study was that half of the patients were from Japan and Korea and we know from many other studies in ovarian cancer that they respond differently to our treatment and their survival is also longer and also in a different way. We know that from the CarboTaxol weekly study; we know that from the pazopanib study; we know that from many other studies. So that is something that we would need to explore further. Also in the GOG213 study the majority of patients had anti-angiogenetic treatment whereas this was not the case in the DESKTOP trial. The final answer will come next year where we are going to have the mature data for overall survival for ovarian cancer, then let’s see.

The second study is in the adjuvant chemotherapy study. This is a study from the Japanese group which compared primary versus interval debulking surgery in advanced ovarian cancer. We have two prospective randomised trials so far that have shown no difference in terms of survival but a trend for higher complications when operating after three cycles. What the Japanese study showed is that they failed to prove a non-inferiority of the interval debulking arm for the first time, meaning that there are patients who actually do not benefit from interval debulking surgery.

There is a large prospective phase III randomised trial now running currently, the TRUST trial, initiated by the German AGO, which is again comparing primary versus interval debulking surgery across many high quality surgical centres worldwide which I think will answer the question.