DESKTOP III: trial | Bending the Curve: Trial by Trial

DESKTOP III

Randomized Trial of Cytoreductive Surgery for Relapsed Ovarian Cancer

Population

Recurrent ovarian cancer, first relapse after a platinum-free interval of 6 months or more, with a positive AGO score

Design

Patients with recurrent ovarian cancer at first relapse after a platinum-free interval of 6 months or more were randomly assigned to secondary cytoreductive surgery followed by platinum-based chemotherapy, or platinum-based chemotherapy alone. Eligibility required a positive AGO score (ECOG performance status 0, ascites under 500 ml, complete resection at initial surgery). The primary end point was overall survival.

Primary endpoint

Arms

Surgery plus chemotherapy (experimental, n = 206): Secondary cytoreductive surgery followed by platinum-based chemotherapy
Chemotherapy alone (control, n = 201): Platinum-based chemotherapy alone

People

Harter P

OSHR 0.75 (95% CI 0.59–0.96)Δ median OS+7.7 months

Show the numbers

Results reported for DESKTOP III
Endpoint	Analysis	Surgery plus chemotherapy	Chemotherapy alone	Effect
OSAll randomised patients (407); analysis population not stated in the abstract	primaryHarter 2021	median 53.7 months	median 46 months	HR 0.75 (95% CI 0.59–0.96)P=0.02Hazard ratio for death, surgery group compared with no-surgery group.
OSPatients in the surgery group with complete resection (denominator not stated in the abstract)	exploratoryHarter 2021	median 61.9 months	—	Median overall survival in the subgroup of the surgery group with complete resection; a single-arm subgroup figure, not a randomised comparison.
Complete resection ratePatients in the surgery group who underwent the procedure	primaryHarter 2021	75.5%	—	—

Results reported for DESKTOP III
Endpoint	Analysis	Surgery plus chemotherapy	Chemotherapy alone	Effect
OSAll randomised patients (407); analysis population not stated in the abstract	primaryHarter 2021	median 53.7 months	median 46 months	HR 0.75 (95% CI 0.59–0.96)P=0.02Hazard ratio for death, surgery group compared with no-surgery group.
OSPatients in the surgery group with complete resection (denominator not stated in the abstract)	exploratoryHarter 2021	median 61.9 months	—	Median overall survival in the subgroup of the surgery group with complete resection; a single-arm subgroup figure, not a randomised comparison.
Complete resection ratePatients in the surgery group who underwent the procedure	primaryHarter 2021	75.5%	—	—

Hazard ratio (95% CI) by endpoint. Values below 1 favour the experimental arm.

Data table

Endpoint	HR	95% CI
OS	0.75	0.59–0.96

Illustrative — modelled from reported values, not trial data. OS, primary.

Show curves

Surgery plus chemotherapy (experimental)
Chemotherapy alone (control)

Median-only curves assume a constant hazard (exponential) and fit plateaus, as seen with some immunotherapies, poorly.

Data table (modelled values)

Months	Surgery plus chemotherapy	Chemotherapy alone
0	100.0%	100.0%
34	64.5%	59.9%
67	42.1%	36.4%
101	27.2%	21.8%
134	17.7%	13.3%

Illustrative — modelled from reported values, not trial data. OS, exploratory.

Show curves

Surgery plus chemotherapy (experimental)

Median-only curves assume a constant hazard (exponential) and fit plateaus, as seen with some immunotherapies, poorly.

Data table (modelled values)

Months	Surgery plus chemotherapy
0	100.0%
39	64.6%
77	42.2%
116	27.3%
155	17.6%

Appears in

2019 Secondary cytoreduction at first relapse: GOG-213, SOC-1, DESKTOP III

Sources

Harter P, Sehouli J, Vergote I, Ferron G, Reuss A, Meier W, et al. Randomized Trial of Cytoreductive Surgery for Relapsed Ovarian Cancer. N Engl J Med. 2021;385(23):2123-2131.
PubMed DOI