Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer

Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline

Alexi A. Wright, Kari Bohlke, Deborah K. Armstrong, Michael A. Bookman, William Arthur Cliby, Robert L. Coleman, Don S. Dizon, Joseph J. Kash, Larissa A. Meyer, Kathleen N. Moore, Alexander B. Olawaiye, Jessica Oldham, Ritu Salani, Dee Sparacio, William P. Tew, Ignace Vergote, Mitchell I. Edelson

Research output: Contribution to journalArticle

103 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)3460-3473
Number of pages14
JournalJournal of Clinical Oncology
Volume34
Issue number28
DOIs
StatePublished - Oct 1 2016

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Medical Oncology
Practice Guidelines
Ovarian Neoplasms
Drug Therapy
Morbidity
Phase III Clinical Trials
Fallopian Tubes
Adjuvant Chemotherapy
Pelvis
Abdomen
Disease-Free Survival
Thorax
Guidelines
Mortality
Ovarian epithelial cancer
Neoplasms

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer : Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline. / Wright, Alexi A.; Bohlke, Kari; Armstrong, Deborah K.; Bookman, Michael A.; Cliby, William Arthur; Coleman, Robert L.; Dizon, Don S.; Kash, Joseph J.; Meyer, Larissa A.; Moore, Kathleen N.; Olawaiye, Alexander B.; Oldham, Jessica; Salani, Ritu; Sparacio, Dee; Tew, William P.; Vergote, Ignace; Edelson, Mitchell I.

In: Journal of Clinical Oncology, Vol. 34, No. 28, 01.10.2016, p. 3460-3473.

Research output: Contribution to journalArticle

Wright, AA, Bohlke, K, Armstrong, DK, Bookman, MA, Cliby, WA, Coleman, RL, Dizon, DS, Kash, JJ, Meyer, LA, Moore, KN, Olawaiye, AB, Oldham, J, Salani, R, Sparacio, D, Tew, WP, Vergote, I & Edelson, MI 2016, 'Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline', Journal of Clinical Oncology, vol. 34, no. 28, pp. 3460-3473. https://doi.org/10.1200/JCO.2016.68.6907
Wright, Alexi A. ; Bohlke, Kari ; Armstrong, Deborah K. ; Bookman, Michael A. ; Cliby, William Arthur ; Coleman, Robert L. ; Dizon, Don S. ; Kash, Joseph J. ; Meyer, Larissa A. ; Moore, Kathleen N. ; Olawaiye, Alexander B. ; Oldham, Jessica ; Salani, Ritu ; Sparacio, Dee ; Tew, William P. ; Vergote, Ignace ; Edelson, Mitchell I. / Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer : Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline. In: Journal of Clinical Oncology. 2016 ; Vol. 34, No. 28. pp. 3460-3473.
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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.",
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T1 - Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer

T2 - Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline

AU - Wright, Alexi A.

AU - Bohlke, Kari

AU - Armstrong, Deborah K.

AU - Bookman, Michael A.

AU - Cliby, William Arthur

AU - Coleman, Robert L.

AU - Dizon, Don S.

AU - Kash, Joseph J.

AU - Meyer, Larissa A.

AU - Moore, Kathleen N.

AU - Olawaiye, Alexander B.

AU - Oldham, Jessica

AU - Salani, Ritu

AU - Sparacio, Dee

AU - Tew, William P.

AU - Vergote, Ignace

AU - Edelson, Mitchell I.

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N2 - 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.

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