2016 ASCO Ovarian Cancer Guidelines for Neo-Adjuvant Chemotherapy

Background

In the recent past years, two randomised controlled clinical trials (RCTs), comparing treatment options for women with advanced and metastatic ovarian cancer, had led to debate among physicians.

“These trials demonstrated that NACT was not inferior to PCS for progression-free and overall survival and resulted in a lower incidence of treatment-related morbidity and mortality.” according to��the authors, indicating the need��for a systemic review and guidelines for practitioners.

“However, both trials have been criticised because of the median overall survival, mean operative time and rates of optimal cytoreduction were lower than expected” explained��the expert panel of the American Society of Clinical Oncology (ASCO) and��Society of Gynecologic Oncology (SGO).

The��guidelines in JCO apply to patients, either newly diagnosed or suspected to have stage IIIC or IV epithelial ovarian cancer, fallopian tube cancer, or primary peritoneal cancer.

Methods

Key Recommendations

The expert panel made the following key recommendations:

• Upon suspicion or diagnosis of stage IIIC or IV invasive ovarian, fallopian tube, or peritoneal cancer, all patients should first be��evaluated by a gynecologic oncologist before initiation of therapy.��Primary clinical evaluation should include:
  • Computed Tomography (CT) of the abdomen and pelvis��with oral and intravenous contrast;
  • Chest imaging, preferably by CT.
• Patients unlikely to achieve a cytoreduction of ��< 1 cm of residual disease, or with a high risk of surgery-related co-morbidities should��receive NACT.
• For patients who are fit to undergo primary cytoreductive surgery, and with potentially resectable disease, a benefit may be derived from either NACT��followed by surgery, or from PCS. Physicians should carefully weigh risks and benefits of the different treatments.
  • Studies indicate progression-free survival and overall survival are equal for both NACT and PCS;
  • NACT is associated lesser morbidity and mortality and shorter hospitalisations;
  • PCS is associated with greater survival benefit��in some patients.