NCCN Guidelines Insights: Ovarian Cancer, Version 1.2019

Featured Updates to the NCCN Guidelines

Authors:
Deborah K. ArmstrongThe Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins;

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Ronald D. AlvarezVanderbilt-Ingram Cancer Center;

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Jamie N. Bakkum-GamezMayo Clinic Cancer Center;

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Lisa BarroilhetUniversity of Wisconsin Carbone Cancer Center;

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Kian BehbakhtUniversity of Colorado Cancer Center;

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Andrew BerchuckDuke Cancer Institute;

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Jonathan S. BerekStanford Cancer Institute;

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Lee-may ChenUCSF Helen Diller Family Comprehensive Cancer Center;

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Mihaela CristeaCity of Hope National Medical Center;

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Marie DeRosaPatient Advocacy;

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Adam C. ElNaggarSt. Jude Children’s Research Hospital/The University of Tennessee Health Science Center;

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David M. GershensonThe University of Texas MD Anderson Cancer Center;

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Heidi J. GrayUniversity of Washington/Seattle Cancer Care Alliance;

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Ardeshir HakamMoffitt Cancer Center;

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Angela JainFox Chase Cancer Center;

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Carolyn JohnstonUniversity of Alabama at Birmingham Comprehensive Cancer Center;

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Charles A. Leath IIIUniversity of Alabama at Birmingham Comprehensive Cancer Center;

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Joyce LiuDana-Farber/Brigham and Women’s Cancer Center;

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Haider MahdiCase Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute;

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Daniela MateiRobert H. Lurie Comprehensive Cancer Center of Northwestern University;

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Michael McHaleUC San Diego Moores Cancer Center;

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Karen McLeanUniversity of Michigan Rogel Cancer Center;

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David M. O’MalleyThe Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute;

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Richard T. PensonMassachusetts General Hospital Cancer Center;

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Sanja Percac-LimaMassachusetts General Hospital Cancer Center;

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Elena RatnerYale Cancer Center/Smilow Cancer Hospital;

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Steven W. RemmengaFred & Pamela Buffett Cancer Center;

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Paul SabbatiniMemorial Sloan Kettering Cancer Center;

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Theresa L. WernerHuntsman Cancer Institute at the University of Utah;

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Emese ZsirosRoswell Park Comprehensive Cancer Center; and

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Jennifer L. BurnsNational Comprehensive Cancer Network.

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Anita M. EnghNational Comprehensive Cancer Network.

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Epithelial ovarian cancer is the leading cause of death from gynecologic cancer in the United States, with less than half of patients living >5 years from diagnosis. A major challenge in treating ovarian cancer is that most patients have advanced disease at initial diagnosis. The best outcomes are observed in patients whose primary treatment includes complete resection of all visible disease plus combination platinum-based chemotherapy. Research efforts are focused on primary neoadjuvant treatments that may improve resectability, as well as systemic therapies providing improved long-term survival. These NCCN Guidelines Insights focus on recent updates to neoadjuvant chemotherapy recommendations, including the addition of hyperthermic intraperitoneal chemotherapy, and the role of PARP inhibitors and bevacizumab as maintenance therapy options in select patients who have completed primary chemotherapy.

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    Onda T, Satoh T, Saito T, et al.. Comparison of treatment invasiveness between upfront debulking surgery versus interval debulking surgery following neoadjuvant chemotherapy for stage III/IV ovarian, tubal, and peritoneal cancers in a phase III randomised trial: Japan Clinical Oncology Group Study JCOG0602. Eur J Cancer 2016;64:2231.

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    Liu EL, Mi RR, Wang DH, et al.. Application of combined intraperitoneal and intravenous neoadjuvant chemotherapy in senile patients with advanced ovarian cancer and massive ascites. Eur J Gynaecol Oncol 2017;38:209213.

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    van Meurs HS, Tajik P, Hof MH, et al.. Which patients benefit most from primary surgery or neoadjuvant chemotherapy in stage IIIC or IV ovarian cancer? An exploratory analysis of the European Organisation for Research and Treatment of Cancer 55971 randomised trial. Eur J Cancer 2013;49:31913201.

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    Tewari KS, Java JJ, Eskander RN, et al.. Early initiation of chemotherapy following complete resection of advanced ovarian cancer associated with improved survival: NRG Oncology/Gynecologic Oncology Group study. Ann Oncol 2016;27:114121.

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    Timmermans M, van der Aa MA, Lalisang RI, et al.. Interval between debulking surgery and adjuvant chemotherapy is associated with overall survival in patients with advanced ovarian cancer. Gynecol Oncol 2018;150:446450.

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  • 25.

    Garcia YG, Juan AD, Mendiola C, et al.. Phase II randomized trial of neoadjuvant (NA) chemotherapy (CT) with or without bevacizumab (Bev) in advanced epithelial ovarian cancer (EOC)‏ (GEICO 1205/NOVA TRIAL) [abstract]. J Clin Oncol 2017;35(Suppl):Abstract 5508.

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    Rouzier R, Gouy S, Selle F, et al.. Efficacy and safety of bevacizumab-containing neoadjuvant therapy followed by interval debulking surgery in advanced ovarian cancer: results from the ANTHALYA trial. Eur J Cancer 2017;70:133142.

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  • 27.

    Provencher DM, Gallagher CJ, Parulekar WR, et al.. OV21/PETROC: a randomized Gynecologic Cancer Intergroup phase II study of intraperitoneal versus intravenous chemotherapy following neoadjuvant chemotherapy and optimal debulking surgery in epithelial ovarian cancer. Ann Oncol 2018;29:431438.

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  • 31.

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    van Driel WJ, Koole SN, Sikorska K, et al.. Hyperthermic intraperitoneal chemotherapy in ovarian cancer. N Engl J Med 2018;378:230240.

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    Di Giorgio A, Naticchioni E, Biacchi D, et al.. Cytoreductive surgery (peritonectomy procedures) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of diffuse peritoneal carcinomatosis from ovarian cancer. Cancer 2008;113:315325.

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    Ceelen WP, Van Nieuwenhove Y, Van Belle S, et al.. Cytoreduction and hyperthermic intraperitoneal chemoperfusion in women with heavily pretreated recurrent ovarian cancer. Ann Surg Oncol 2012;19:23522359.

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    Tentes AA, Kakolyris S, Kyziridis D, et al.. Cytoreductive surgery combined with hyperthermic intraperitoneal intraoperative chemotherapy in the treatment of advanced epithelial ovarian cancer. J Oncol 2012;2012:358341.

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    Gonzalez Bayon L, Steiner MA, Vasquez Jimenez W, et al.. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for the treatment of advanced epithelial ovarian carcinoma: upfront therapy, at first recurrence, or later? Eur J Surg Oncol 2013;39:11091115.

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    Gouy S, Ferron G, Glehen O, et al.. Results of a multicenter phase I dose-finding trial of hyperthermic intraperitoneal cisplatin after neoadjuvant chemotherapy and complete cytoreductive surgery and followed by maintenance bevacizumab in initially unresectable ovarian cancer. Gynecol Oncol 2016;142:237242.

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    Lee YJ, Lee JY, Cho MS, et al.. Incorporation of paclitaxel-based hyperthermic intraperitoneal chemotherapy in patients with advanced-stage ovarian cancer treated with neoadjuvant chemotherapy followed by interval debulking surgery: a protocol-based pilot study. J Gynecol Oncol 2019;30:e3.

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    Montori G, Coccolini F, Fugazzola P, et al.. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in ovarian and gastrointestinal peritoneal carcinomatosis: results from a 7-year experience. J Gastrointest Oncol 2018;9:241253.

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    Ba M, Long H, Zhang X, et al.. Hyperthermic intraperitoneal perfusion chemotherapy and cytoreductive surgery for controlling malignant ascites from ovarian cancer. Int J Gynecol Cancer 2016;26:15711579.

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    Friedlander M, Rau J, Lee CK, et al.. Quality of life in patients with advanced epithelial ovarian cancer (EOC) randomized to maintenance pazopanib or placebo after first-line chemotherapy in the AGO-OVAR 16 trial. Measuring what matters-patient-centered end points in trials of maintenance therapy. Ann Oncol 2018;29:737743.

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    Burger RA, Brady MF, Bookman MA, et al.. Incorporation of bevacizumab in the primary treatment of ovarian cancer. N Engl J Med 2011;365:24732483.

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    Oza AM, Cook AD, Pfisterer J, et al.. Standard chemotherapy with or without bevacizumab for women with newly diagnosed ovarian cancer (ICON7): overall survival results of a phase 3 randomised trial. Lancet Oncol 2015;16:928936.

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    Ferriss JS, Java JJ, Bookman MA, et al.. Ascites predicts treatment benefit of bevacizumab in front-line therapy of advanced epithelial ovarian, fallopian tube and peritoneal cancers: an NRG Oncology/GOG study. Gynecol Oncol 2015;139:1722.

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    Norquist BM, Brady MF, Harrell MI, et al.. Mutations in homologous recombination genes and outcomes in ovarian carcinoma patients in GOG 218: an NRG Oncology/Gynecologic Oncology Group study. Clin Cancer Res 2018;24:777783.

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