Neoadjuvant Chemotherapy for Newly Diagnosed, Advanced Ovarian Cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline

Abstract

Purpose To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer. Methods The Society of Gynecologic Oncology and the American Society of Clinical Oncology convened an Expert Panel and conducted a systematic review of the literature. Results Four phase III clinical trials form the primary evidence base for the recommendations. The published studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer, neoadjuvant chemotherapy and interval cytoreduction are noninferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioperative morbidity and mortality. 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. Additional information is available at www.asco.org/NACT-ovarian-guideline and www.asco.org/guidelineswiki.

The USP7 Inhibitor P5091 Induces Cell Death in Ovarian Cancers with Different P53 Status

“…Unfortunately, patients are often diagnosed at the later stages of the disease, thus facing limited therapeutic options and poor clinical outcomes [26]. Neoadjuvant therapy combining chemotherapy and surgery has proven effective and is frequently clinically administered [27, 28]. Recent progressions in targeted therapy for ovarian cancer management involve PARP inhibitors exemplified by olaparib and rucaparib, which have shown promising results for patients carrying mutations in BRCA1 or BRCA2 [29, 30].…”

Neoadjuvant therapy in gynaecological malignancies: What pathologists need to know

“…In the past, treatment with primary cytoreductive surgery (PCS) followed by chemotherapy was the standard of care for women with ovarian malignancy 1. NACT was only indicated in women who were not fit for surgery, where the tumour was considered so advanced that total surgical removal could not be achieved, or when it was not realised at laparotomy that the tumour was ovarian in origin 2…”

“…The Society of Gynecologic Oncology and the American Society of Clinical Oncology published a comprehensive Clinical Practice Guideline (the SGO/ASCO clinical practice guideline) to guide and inform all physicians involved in the care of patients with newly diagnosed, advanced ovarian cancer 1. The pertinent points of this guideline are highlighted in the following subsections.…”

“…All women with suspected stage IIIC or IV invasive epithelial ovarian cancer should be evaluated by a gynaecological oncologist prior to the initiation of any treatment, to determine what therapy would be most appropriate 1. It has been shown that women with ovarian cancer who are treated by a gynaecological oncologist are more likely to undergo proper staging, and receive adjuvant chemotherapy, compared with those treated by gynaecologists and general surgeons, and are more likely to have superior survival 5–7.…”

“…The majority of women with high-grade serous carcinoma (HGSC) of ovarian, tubal or peritoneal origin are diagnosed at advanced stage and have a poor prognosis 1. Efforts are ongoing to tailor treatment to improve the outcome for these patients.…”