The Society of Gynecologic Oncology and the American Society of Clinical Oncology (ASCO) recently issued a clinical oncology practice guideline to provide guidance to clinicians on the use of neoadjuvant chemotherapy (NACT) and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer. Among the recommendations:
- All women with suspected stage IIIC or IV invasive epithelial ovarian cancer should be evaluated by a gynecologic oncologist prior to initiation of therapy.
- The primary clinical evaluation should include a CT of the abdomen and pelvis, and chest imaging (CT preferred).
- Women with a high perioperative risk profile or a low likelihood of achieving cytoreduction to < 1 cm of residual disease (ideally to no visible disease) should receive neoadjuvant chemotherapy.
- Women who are fit for primary cytoreductive surgery, and with potentially resectable disease, may receive either neoadjuvant chemotherapy or primary cytoreductive surgery.
- However, primary cytoreductive surgery is preferred if there is a high likelihood of achieving cytoreduction to < 1 cm (ideally to no visible disease) with acceptable morbidity.
- Before neoadjuvant chemotherapy is delivered, all patients should have confirmation of an invasive ovarian, fallopian tube, or peritoneal cancer.
- For NACT, a platinum/taxane doublet is recommended. However, alternate regimens, containing a platinum agent, may be selected based on individual patient factors.
- RCTs tested surgery following 3 or 4 cycles of chemotherapy in women who had a response to NACT or stable disease. Interval cytoreductive surgery should be performed after ≤ 4 cycles of NACT for women with a response to chemotherapy or stable disease. Alternate timing of surgery has not been prospectively evaluated but may be considered based on patient-centered factors.
- Patients with progressive disease on NACT have a poor prognosis. Options include alternative chemotherapy regimens, clinical trials, and/or discontinuation of active cancer therapy and initiation of end-of-life care.
Wright AA, Bohlke K, Armstrong DK, et al. Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline. [Published online ahead of print August 8, 2016]. J Clin Oncol. doi:10.1200/JCO.2016.68.6907.