NCCN Guidelines® Insights: Ovarian Cancer, Version 3.2022

Featured Updates to the NCCN Guidelines

View More View Less
  • 1 The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins;
  • | 2 Vanderbilt-Ingram Cancer Center;
  • | 3 The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute;
  • | 4 Mayo Clinic Cancer Center;
  • | 5 University of Wisconsin Carbone Cancer Center;
  • | 6 University of Colorado Cancer Center;
  • | 7 Duke Cancer Institute;
  • | 8 UCSF Helen Diller Family Comprehensive Cancer Center;
  • | 9 Memorial Sloan Kettering Cancer Center;
  • | 10 City of Hope National Medical Center;
  • | 11 Patient advocate;
  • | 12 Massachusetts General Hospital Cancer Center;
  • | 13 The University of Texas MD Anderson Cancer Center;
  • | 14 University of Washington/Seattle Cancer Care Alliance;
  • | 15 Moffitt Cancer Center;
  • | 16 Fox Chase Cancer Center;
  • | 17 Stanford Cancer Institute;
  • | 18 UCLA Jonsson Comprehensive Cancer Center;
  • | 19 O'Neal Comprehensive Cancer Center at UAB;
  • | 20 UC Davis Comprehensive Cancer Center;
  • | 21 Dana-Farber/Brigham and Women’s Cancer Center;
  • | 22 Abramson Cancer Center at the University of Pennsylvania;
  • | 23 Robert H. Lurie Comprehensive Cancer Center of Northwestern University;
  • | 24 UC San Diego Moores Cancer Center;
  • | 25 University of Michigan Rogel Cancer Center;
  • | 26 UT Southwestern Simmons Comprehensive Cancer Center;
  • | 27 Fred & Pamela Buffett Cancer Center;
  • | 28 St. Jude Children's Research Hospital/The University of Tennessee Health Science Center;
  • | 29 Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine;
  • | 30 Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute;
  • | 31 Huntsman Cancer Institute at the University of Utah;
  • | 32 Roswell Park Comprehensive Cancer Center; and
  • | 33 National Comprehensive Cancer Network.

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 following diagnosis. The NCCN Guidelines for Ovarian Cancer provide recommendations for the diagnosis, evaluation, treatment, and follow-up for patients with ovarian, fallopian tube, and primary peritoneal cancers. These NCCN Guidelines Insights summarize the panel discussion behind recent important updates to the guidelines, including revised guidance on alternative chemotherapy regimens for patients with advanced age and/or comorbidities, a new algorithm for recurrent low-grade serous carcinoma based on developing research and novel therapeutic agents, and updated language regarding tumor molecular analysis applications in ovarian cancer.

  • 1.

    Kurman RJ, Carcangiu ML, Harrington CS, et al. WHO Classification of Tumours of Female Reproductive Organs, 4th ed. Lyon, France: IARC Publications; 2014.

    • Search Google Scholar
    • Export Citation
  • 2.

    Chan JK, Cheung MK, Husain A, et al. Patterns and progress in ovarian cancer over 14 years. Obstet Gynecol 2006;108:521528.

  • 3.

    Prat J. New insights into ovarian cancer pathology. Ann Oncol 2012;23(Suppl 10):X111117.

  • 4.

    Jelovac D, Armstrong DK. Recent progress in the diagnosis and treatment of ovarian cancer. CA Cancer J Clin 2011;61:183203.

  • 5.

    Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022. CA Cancer J Clin 2022;72:733.

  • 6.

    Peres LC, Cushing-Haugen KL, Köbel M, et al. Invasive epithelial ovarian cancer survival by histotype and disease stage. J Natl Cancer Inst 2019;111:6068.

  • 7.

    Park HK, Ruterbusch JJ, Cote ML. Recent trends in ovarian cancer incidence and relative survival in the United States by race/ethnicity and histologic subtypes. Cancer Epidemiol Biomarkers Prev 2017;26:15111518.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Howlader N, Noone A, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2014, National Cancer Institute. Bethesda, MD. Based on November 2016 SEER data submission, posted to the SEER web site, April 2017. Accessed July 6, 2022. Available at: https://seer.cancer.gov/csr/1975_2014/

    • Search Google Scholar
    • Export Citation
  • 9.

    Stewart SL, Harewood R, Matz M, et al. Disparities in ovarian cancer survival in the United States (2001-2009): findings from the CONCORD-2 study. Cancer 2017;123(Suppl 24):51385159.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Hilpert F, du Bois A, Greimel ER, et al. Feasibility, toxicity and quality of life of first-line chemotherapy with platinum/paclitaxel in elderly patients aged ≥70 years with advanced ovarian cancer—a study by the AGO OVAR Germany. Ann Oncol 2007;18:282287.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Selle F, Colombo N, Korach J, et al. Safety and efficacy of extended bevacizumab therapy in elderly (≥70 years) versus younger patients treated for newly diagnosed ovarian cancer in the international ROSiA study. Int J Gynecol Cancer 2018;28:729737.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Fairfield KM, Murray K, Lucas FL, et al. Completion of adjuvant chemotherapy and use of health services for older women with epithelial ovarian cancer. J Clin Oncol 2011;29:39213926.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Falandry C, Savoye AM, Stefani L, et al. EWOC-1: a randomized trial to evaluate the feasibility of three different first-line chemotherapy regimens for vulnerable elderly women with ovarian cancer (OC): a GCIG-ENGOT-GINECO study [abstract]. J Clin Oncol 2019;37:Abstract 5508.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Hershman DL, Till C, Wright JD, et al. Comorbidities and risk of chemotherapy-induced peripheral neuropathy among participants 65 years or older in Southwest Oncology Group clinical trials. J Clin Oncol 2016;34:30143022.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Freyer G, Geay JF, Touzet S, et al. Comprehensive geriatric assessment predicts tolerance to chemotherapy and survival in elderly patients with advanced ovarian carcinoma: a GINECO study. Ann Oncol 2005;16:17951800.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Trédan O, Geay JF, Touzet S, et al. Carboplatin/cyclophosphamide or carboplatin/paclitaxel in elderly patients with advanced ovarian cancer? Analysis of two consecutive trials from the Groupe d’Investigateurs Nationaux pour l’Etude des Cancers Ovariens. Ann Oncol 2007;18:256262.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Falandry C, Weber B, Savoye AM, et al. Development of a geriatric vulnerability score in elderly patients with advanced ovarian cancer treated with first-line carboplatin: a GINECO prospective trial. Ann Oncol 2013;24:28082813.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Tinquaut F, Freyer G, Chauvin F, et al. Prognostic factors for overall survival in elderly patients with advanced ovarian cancer treated with chemotherapy: results of a pooled analysis of three GINECO phase II trials. Gynecol Oncol 2016;143:2226.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    von Gruenigen VE, Huang HQ, Beumer JH, et al. Chemotherapy completion in elderly women with ovarian, primary peritoneal or fallopian tube cancer – an NRG oncology/Gynecologic Oncology Group study. Gynecol Oncol 2017;144:459467.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Hurria A, Togawa K, Mohile SG, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol 2011;29:34573465.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    International Collaborative Ovarian Neoplasm Group. Paclitaxel plus carboplatin versus standard chemotherapy with either single-agent carboplatin or cyclophosphamide, doxorubicin, and cisplatin in women with ovarian cancer: the ICON3 randomised trial. Lancet 2002;360:505515.

    • Search Google Scholar
    • Export Citation
  • 22.

    ICON Collaborators. ICON2: randomised trial of single-agent carboplatin against three-drug combination of CAP (cyclophosphamide, doxorubicin, and cisplatin) in women with ovarian cancer. Lancet 1998;352:15711576.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Falandry C, Rousseau F, Mouret-Reynier MA, et al. Efficacy and safety of first-line single-agent carboplatin vs carboplatin plus paclitaxel for vulnerable older adult women with ovarian cancer: a GINECO/GCIG randomized clinical trial. JAMA Oncol 2021;7:853861.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Pignata S, Scambia G, Katsaros D, et al. Carboplatin plus paclitaxel once a week versus every 3 weeks in patients with advanced ovarian cancer (MITO-7): a randomised, multicentre, open-label, phase 3 trial. Lancet Oncol 2014;15:396405.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Pignata S, Breda E, Scambia G, et al. A phase II study of weekly carboplatin and paclitaxel as first-line treatment of elderly patients with advanced ovarian cancer: a Multicentre Italian Trial in Ovarian cancer (MITO-5) study. Crit Rev Oncol Hematol 2008;66:229236.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Committee on the State of the Science in Ovarian Cancer Research. Ovarian Cancers: Evolving Paradigms in Research and Care. Washington, DC: National Academies Press; 2016.

    • Search Google Scholar
    • Export Citation
  • 27.

    Prat J, D’Angelo E, Espinosa I. Ovarian carcinomas: at least five different diseases with distinct histological features and molecular genetics. Hum Pathol 2018;80:1127.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Bodurka DC, Deavers MT, Tian C, et al. Reclassification of serous ovarian carcinoma by a 2-tier system: a Gynecologic Oncology Group study. Cancer 2012;118:30873094.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Malpica A, Deavers MT, Lu K, et al. Grading ovarian serous carcinoma using a two-tier system. Am J Surg Pathol 2004;28:496504.

  • 30.

    Jones S, Wang TL, Kurman RJ, et al. Low-grade serous carcinomas of the ovary contain very few point mutations. J Pathol 2012;226:413420.

  • 31.

    Wong KK, Tsang YT, Deavers MT, et al. BRAF mutation is rare in advanced-stage low-grade ovarian serous carcinomas. Am J Pathol 2010;177:16111617.

  • 32.

    Cheasley D, Nigam A, Zethoven M, et al. Genomic analysis of low-grade serous ovarian carcinoma to identify key drivers and therapeutic vulnerabilities. J Pathol 2021;253:4154.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Cancer Genome Atlas Research Network. Integrated genomic analyses of ovarian carcinoma. Nature 2011;474:609615.

  • 34.

    Patch AM, Christie EL, Etemadmoghadam D, et al. Whole-genome characterization of chemoresistant ovarian cancer. Nature 2015;521:489494.

  • 35.

    Gershenson DM, Sun CC, Westin SN, et al. The genomic landscape of low-grade serous ovarian/peritoneal carcinoma and its impact on clinical outcomes. Gynecol Oncol 2022;165:560567.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Gourley C, Farley J, Provencher DM, et al. Gynecologic Cancer InterGroup (GCIG) consensus review for ovarian and primary peritoneal low-grade serous carcinomas. Int J Gynecol Cancer 2014;24:S913.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Gershenson DM, Sun CC, Lu KH, et al. Clinical behavior of stage II-IV low-grade serous carcinoma of the ovary. Obstet Gynecol 2006;108:361368.

  • 38.

    Amin M, Edge S, Greene F, et al. eds. AJCC Cancer Staging Manual, 8th ed. Cham, Switzerland: Springer Nature Switzerland AG; 2017.

  • 39.

    Cobb LP, Sun CC, Iyer R, et al. The role of neoadjuvant chemotherapy in the management of low-grade serous carcinoma of the ovary and peritoneum: further evidence of relative chemoresistance. Gynecol Oncol 2020;158:653658.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Gershenson DM, Bodurka DC, Coleman RL, et al. Hormonal maintenance therapy for women with low-grade serous cancer of the ovary or peritoneum. J Clin Oncol 2017;35:11031111.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41.

    Fader AN, Bergstrom J, Jernigan A, et al. Primary cytoreductive surgery and adjuvant hormonal monotherapy in women with advanced low-grade serous ovarian carcinoma: reducing overtreatment without compromising survival? Gynecol Oncol 2017;147:8591.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Gershenson DM, Sun CC, Iyer RB, et al. Hormonal therapy for recurrent low-grade serous carcinoma of the ovary or peritoneum. Gynecol Oncol 2012;125:661666.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43.

    Gershenson DM, Sun CC, Bodurka D, et al. Recurrent low-grade serous ovarian carcinoma is relatively chemoresistant. Gynecol Oncol 2009;114:4852.

  • 44.

    Gershenson DM, Miller A, Brady WE, et al. Trametinib versus standard of care in patients with recurrent low-grade serous ovarian cancer (GOG 281/LOGS): an international, randomised, open-label, multicentre, phase 2/3 trial. Lancet 2022;399:541553.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Monk BJ, Grisham RN, Banerjee S, et al. MILO/ENGOT-ov11: binimetinib versus physician’s choice chemotherapy in recurrent or persistent low-grade serous carcinomas of the ovary, fallopian tube, or primary peritoneum. J Clin Oncol 2020;38:37533762.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 46.

    U.S. Food & Drug Administration. FDA grants accelerated approval to dabrafenib in combination with trametinib for unresectable or metastatic solid tumors with BRAF V600E mutation. Accessed July 1, 2022. Available at: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-dabrafenib-combination-trametinib-unresectable-or-metastatic-solid

    • Search Google Scholar
    • Export Citation
  • 47.

    Tafinlar (capsules) [prescribing information]. East Hanover, New Jersey: Novartis Pharmaceuticals Corporation; 2022.

  • 48.

    Mekinist (tablets) [prescribing information]. East Hanover, New Jersey: Novartis Pharmaceuticals Corporation; 2022.

  • 49.

    Salama AKS, Li S, Macrae ER, et al. dabrafenib and trametinib in patients with tumors with BRAFV600E mutations: results of the NCI-MATCH trial subprotocol H. J Clin Oncol 2020;38:38953904.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 1327 1327 1327
PDF Downloads 1047 1047 1047
EPUB Downloads 0 0 0