Surgery or Chemotherapy in Recurrent Ovarian Cancer (SOC 1 Trial)?

• Progression-free survival [ Time Frame: Progression-free survival is defined as interval between date of randomization and 2nd relapse/progression or death (whatever occurs first), assessed up to 36 months. ] [ Designated as safety issue: No ]
• Quality of Life [ Time Frame: Baseline, 6, 12, and 24 months after randomization ] [ Designated as safety issue: Yes ]
• complications incidence [ Time Frame: From the operation until after 60 days ] [ Designated as safety issue: Yes ]

• Progression-free survival [ Time Frame: Progression-free survival is defined as interval between date of randomization and 2nd relapse/progression or death (whatever occurs first), assessed up to 120 months. ] [ Designated as safety issue: No ]
• Quality of Life [ Time Frame: Baseline, 6, 12, and 24 months after randomization ] [ Designated as safety issue: No ]
• complications incidence [ Time Frame: From the operation until after 60 days ] [ Designated as safety issue: No ]

The purpose of this study is to evaluate the role of secondary cytoreduction (SCR) and validate the risk model of patient selection criteria in platinum-sensitive recurrent ovarian cancer.

The primary objective of this study is to compare overall survival (OS) in patients with platinum-sensitive recurrent ovarian cancer with a positive SCR score randomized to secondary cytoreductive surgery followed by chemotherapy versus chemotherapy alone.

• Ovarian Epithelial Cancer Recurrent
• Fallopian Tube Carcinoma
• Primary Peritoneal Carcinoma

• Procedure: Secondary Cytoreductive Surgery
  Complete Cytoreduction
  Other Name: Debulking Surgery
• Drug: Salvage Chemotherapy

• Experimental: secondary cytoreductive surgery
  SCR followed by chemotherapy
  Interventions:

  • Procedure: Secondary Cytoreductive Surgery
  • Drug: Salvage Chemotherapy
• Active Comparator: Salvage Chemotherapy
  platinum-based chemotherapy
  Intervention: Drug: Salvage Chemotherapy

Inclusion Criteria:

• Age at recurrence ≥ 18 years
• Patients with platinum-sensitive, first relapsed epithelial ovarian, primary peritoneal, or fallopian tube cancer (EOC, PPC, FTC), which is defined as those with treatment -free interval of 6 months or more.
• A complete secondary cytoreduction predicting score, iMODEL [Tian WJ, Ann Surg Oncol 2012,19(2):597-604]<=4.7, including FIGO stage (0 or 0.8); residual disease after primary surgery (0 or 1.5); Progression-free interval (0 or 2.4); PS ECOG (0 or 2.4); Ca125 (0 or 1.8); and ascites at recurrence (0 or 3.0).
• Assessed by the experienced surgeons, complete resection of all recurrent disease is possible. If single lesion outside the peritoneal cavity can be resected, MRI/CT or PET/CT scan should be performed to exclude simultaneous intra-abdominal lesions.
• Patients who have given their signed and written informed consent and their consent.

Exclusion Criteria:

• Patients with borderline tumors as well as non-epithelial tumors.
• Patients for interval-debulking, or for second-look surgery, or palliative surgery planned.
• Impossible to assess the resectability or evaluate the score. Radiological signs suggesting complete resection is impossible.
• More than one prior chemotherapy.
• Second relapse or more
• Patients with second or other malignancies who have been treated by surgery, if the treatment might interfere with the treatment of relapsed ovarian cancer or if major impact on prognosis is expected.
• Progression during chemotherapy or recurrence within 6 months after first-line therapy

• Any contradiction not allowing surgery and/or chemotherapy

  1. Accompanied by hypoxia serious chronic obstructive pulmonary disease
  2. Uncontrolled hypertension, cerebrovascular accident/ Stroke, myocardial infarct, unstable angina, untreated thrombosis, chronic congestive heart failure, or serious arrhythmia in need of medicine.
  3. Severe hepatitis, history of liver disease, nephrotic syndrome, renal insufficiency
  4. Active ulcer history, abdominal wall fistula, perforation of gastrointestinal tract, or Intra-abdominal abscess, or simultaneously apply treatment/prevent ulcers therapy.
  5. Uncontrolled diabetes
  6. Uncontrolled epilepsy need long-term antiepileptic treatment.
• Any medication induced considerable risk of surgery, e.g. estimated bleeding due to oral anticoagulating agents, or bevacizumab)

• Fudan University
• Zhejiang Cancer Hospital