NCCN Guidelines® Insights: Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer, Version 3.2024

Featured Updates to the NCCN Guidelines

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Joyce Liu Dana-Farber/Brigham and Women’s Cancer Center

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Andrew Berchuck Duke Cancer Institute

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Floor J. Backes The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute

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Joshua Cohen City of Hope National Medical Center

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Rachel Grisham Memorial Sloan Kettering Cancer Center

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Charles A. Leath III O’Neal Comprehensive Cancer Center at UAB

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Lainie Martin Abramson Cancer Center at the University of Pennsylvania

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Daniela Matei Robert H. Lurie Comprehensive Cancer Center of Northwestern University

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David S. Miller UT Southwestern Simmons Comprehensive Cancer Center

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Sharon Robertson Indiana University Melvin and Bren Simon Comprehensive Cancer Center

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Lisa Barroilhet University of Wisconsin Carbone Cancer Center

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Shitanshu Uppal University of Michigan Rogel Cancer Center

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Andrea Wahner Hendrickson Mayo Clinic Comprehensive Cancer Center

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David M. Gershenson The University of Texas MD Anderson Cancer Center

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Heidi J. Gray Fred Hutch Cancer Center

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Ardeshir Hakam Moffitt Cancer Center

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Angela Jain Fox Chase Cancer Center

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Gottfried E. Konecny UCLA Jonsson Comprehensive Cancer Center

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John Moroney The UChicago Medicine Comprehensive Cancer Center

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Elena Ratner Yale Cancer Center/Smilow Cancer Hospital

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John Schorge St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center

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Premal H. Thaker Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

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Theresa L. Werner Huntsman Cancer Institute at the University of Utah

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Emese Zsiros Roswell Park Comprehensive Cancer Center

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Kian Behbakht University of Colorado Cancer Center

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Lee-May Chen UCSF Helen Diller Family Comprehensive Cancer Center

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Marie DeRosa Patient Advocate

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Eric L. Eisenhauer Mass General Cancer Center

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Gary Leiserowitz UC Davis Comprehensive Cancer Center

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Babak Litkouhi Stanford Cancer Institute

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Michael McHale UC San Diego Moores Cancer Center

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Sanja Percac-Lima Mass General Cancer Center

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Kerry Rodabaugh Fred & Pamela Buffett Cancer Center

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Roberto Vargas Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute

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Frankie Jones National Comprehensive Cancer Network

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Emily Kovach National Comprehensive Cancer Network

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Lisa Hang National Comprehensive Cancer Network

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Swathi Ramakrishnan National Comprehensive Cancer Network

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Ronald D. Alvarez Vanderbilt-Ingram Cancer Center

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Deborah K. Armstrong Johns Hopkins Kimmel Cancer Center

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The NCCN Guidelines for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer provide multidisciplinary diagnostic workup, staging, and treatment recommendations for this disease. These NCCN Guidelines Insights detail how the evolution of the use of PARP inhibitors as maintenance and single-agent regimens for the treatment of ovarian cancer informed panel recommendations in the guidelines.

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  • 1.

    Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin 2024;74:1249.

  • 2.

    Alsop K, Fereday S, Meldrum C, et al. BRCA mutation frequency and patterns of treatment response in BRCA mutation-positive women with ovarian cancer: a report from the Australian Ovarian Cancer Study Group. J Clin Oncol 2012;30:26542663.

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  • 3.

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

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    Tutt A, Bertwistle D, Valentine J, et al. Mutation in BRCA2 stimulates error-prone homology-directed repair of DNA double-strand breaks occurring between repeated sequences. EMBO J 2001;20:47044716.

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  • 5.

    Moynahan ME, Chiu JW, Koller BH, Jasin M. BRCA1 controls homology-directed DNA repair. Mol Cell 1999;4:511518.

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    Lee JM, Ledermann JA, Kohn EC. PARP inhibitors for BRCA1/2 mutation-associated and BRCA-like malignancies. Ann Oncol 2014;25:3240.

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    Moore K, Colombo N, Scambia G, et al. Maintenance olaparib in patients with newly diagnosed advanced ovarian cancer. N Engl J Med 2018;379:24952505.

  • 8.

    Banerjee S, Moore KN, Colombo N, et al. 811MO Maintenance olaparib for patients (pts) with newly diagnosed, advanced ovarian cancer (OC) and a BRCA mutation (BRCAm): 5-year (y) follow-up (f/u) from SOLO1. Ann Oncol 2020;31:S613.

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  • 9.

    DiSilvestro P, Banerjee S, Colombo N, et al. Overall survival with maintenance olaparib at a 7-year follow-up in patients with newly diagnosed advanced ovarian cancer and a BRCA mutation: the SOLO1/GOG 3004 trial. J Clin Oncol 2023;41:609617.

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  • 10.

    Ray-Coquard I, Leary A, Pignata S, et al. Olaparib plus bevacizumab first-line maintenance in ovarian cancer: final overall survival results from the PAOLA-1/ENGOT-ov25 trial. Ann Oncol 2023;34:681692.

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  • 11.

    Gonzalez-Martin A, Pothuri B, Vergote I, et al. Niraparib in patients with newly diagnosed advanced ovarian cancer. N Engl J Med 2019;381:23912402.

  • 12.

    Monk BJ, Barretina-Ginesta MP, Pothuri B, et al. Niraparib first-line maintenance therapy in patients with newly diagnosed advanced ovarian cancer: final overall survival results from PRIMA/ENGOT-OV26/GOG-3012 trial. Ann Oncol. Published online August 21, 2024. doi:10.1016/j.annonc.2024.08.2241

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  • 13.

    Monk BJ, Parkinson C, Lim MC, et al. A randomized, phase III trial to evaluate rucaparib monotherapy as maintenance treatment in patients with newly diagnosed ovarian cancer (ATHENA-MONO/GOG-3020/ENGOT-ov45). J Clin Oncol 2022;40:39523964.

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  • 14.

    O’Malley DM, Oza AM, Lorusso D, et al. Clinical and molecular characteristics of ARIEL3 patients who derived exceptional benefit from rucaparib maintenance treatment for high-grade ovarian carcinoma. Gynecol Oncol 2022;167:404413.

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  • 15.

    Hardesty MM, Krivak TC, Wright GS, et al. OVARIO phase II trial of combination niraparib plus bevacizumab maintenance therapy in advanced ovarian cancer following first-line platinum-based chemotherapy with bevacizumab. Gynecol Oncol 2022;166:219229.

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  • 16.

    Arora S, Balasubramaniam S, Zhang H, et al. FDA approval summary: olaparib monotherapy or in combination with bevacizumab for the maintenance treatment of patients with advanced ovarian cancer. Oncologist 2021;26:e164172.

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  • 17.

    US Food & Drug Administration. FDA approves niraparib for first-line maintenance of advanced ovarian cancer. Accessed December 9, 2022. Available at: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-niraparib-first-line-maintenance-advanced-ovarian-cancer

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  • 18.

    US Food & Drug Administration. FDA approves rucaparib for maintenance treatment of recurrent ovarian, fallopian tube, or primary peritoneal cancer. Accessed December 9, 2022. Available at: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-rucaparib-maintenance-treatment-recurrent-ovarian-fallopian-tube-or-primary-peritoneal

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  • 19.

    Gelmon KA, Tischkowitz M, Mackay H, et al. Olaparib in patients with recurrent high-grade serous or poorly differentiated ovarian carcinoma or triple-negative breast cancer: a phase 2, multicentre, open-label, non-randomised study. Lancet Oncol 2011;12:852861.

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  • 20.

    Audeh MW, Carmichael J, Penson RT, et al. Oral poly(ADP-ribose) polymerase inhibitor olaparib in patients with BRCA1 or BRCA2 mutations and recurrent ovarian cancer: a proof-of-concept trial. Lancet 2010;376:245251.

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  • 21.

    Fong PC, Yap TA, Boss DS, et al. Poly(ADP)-ribose polymerase inhibition: frequent durable responses in BRCA carrier ovarian cancer correlating with platinum-free interval. J Clin Oncol 2010;28:25122519.

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  • 22.

    Deeks ED. Olaparib: first global approval. Drugs 2015;75:231240.

  • 23.

    Kim G, Ison G, McKee AE, et al. FDA approval summary: olaparib monotherapy in patients with deleterious germline BRCA-mutated advanced ovarian cancer treated with three or more lines of chemotherapy. Clin Cancer Res 2015;21:42574261.

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  • 24.

    Swisher EM, Lin KK, Oza AM, et al. Rucaparib in relapsed, platinum-sensitive high-grade ovarian carcinoma (ARIEL2 Part 1): an international, multicentre, open-label, phase 2 trial. Lancet Oncol 2017;18:7587.

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  • 25.

    Balasubramaniam S, Beaver JA, Horton S, et al. FDA approval summary: rucaparib for the treatment of patients with deleterious BRCA mutation-associated advanced ovarian cancer. Clin Cancer Res 2017;23:71657170.

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  • 26.

    Mirza MR, Monk BJ, Herrstedt J, et al. Niraparib maintenance therapy in platinum-sensitive, recurrent ovarian cancer. N Engl J Med 2016;375:21542164.

  • 27.

    Kristeleit R, Lisyanskaya A, Fedenko A, et al. Rucaparib versus standard-of-care chemotherapy in patients with relapsed ovarian cancer and a deleterious BRCA1 or BRCA2 mutation (ARIEL4): an international, open-label, randomised, phase 3 trial. Lancet Oncol 2022;23:465478.

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  • 28.

    Kristeleit R, Shapiro GI, Burris HA, et al. A phase I-II study of the oral PARP inhibitor rucaparib in patients with germline BRCA1/2-mutated ovarian carcinoma or other solid tumors. Clin Cancer Res 2017;23:40954106.

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  • 29.

    Important Prescribing Information: rucaparib for treatment of BRCA- mutated ovarian cancer after 2 or more chemotherapies is voluntarily withdrawn in the US. Accessed August 22, 2022. Available at: https://clovisoncology.com/pdfs/US_DHCPL_final_signed.pdf

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  • 30.

    Kaufman B, Shapira-Frommer R, Schmutzler RK, et al. Olaparib monotherapy in patients with advanced cancer and a germline BRCA1/2 mutation. J Clin Oncol 2015;33:244250.

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  • 31.

    Penson RT, Valencia RV, Cibula D, et al. Olaparib versus nonplatinum chemotherapy in patients with platinum-sensitive relapsed ovarian cancer and a germline BRCA1/2 mutation (SOLO3): a randomized phase III trial. J Clin Oncol 2020;38:11641174.

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  • 32.

    Penson R, Valencia RV, Colombo N, et al. Final overall survival results from SOLO3: phase III trial assessing olaparib monotherapy versus non-platinum chemotherapy in heavily pretreated patients with germline BRCA1 - and/or BRCA2-mutated platinum-sensitive relapsed ovarian cancer (026). Gynecol Oncol 2022;166:S1920.

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  • 33.

    AstraZeneca. Dear Health Care Provider Letter (Olaparib) - September 2023. Accessed December 9, 2022. Available at: https://www.lynparzahcp.com/content/dam/physician-services/us/590-lynparza-hcp-branded/hcp-global/pdf/solo3-dhcp-final-signed.pdf

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  • 34.

    GSK. Dear Health Care Provider Letter (Niraparib) - November 2022. Accessed December 9, 2022. Available at: https://www.zejulahcp.com/content/dam/cf-pharma/hcp-zejulahcp-v2/en_US/pdf/ZEJULA%20(niraparib)%20Dear%20HCP%20Letter%20November%202022.pdf

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  • 35.

    Morice PM, Leary A, Dolladille C, et al. Myelodysplastic syndrome and acute myeloid leukaemia in patients treated with PARP inhibitors: a safety meta-analysis of randomised controlled trials and a retrospective study of the WHO pharmacovigilance database. Lancet Haematol 2021;8:e122134.

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  • 36.

    Poveda A, Floquet A, Ledermann JA, et al. Olaparib tablets as maintenance therapy in patients with platinum-sensitive relapsed ovarian cancer and a BRCA1/2 mutation (SOLO2/ENGOT-Ov21): a final analysis of a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Oncol 2021;22:620631.

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  • 37.

    Coleman RL, Oza A, Lorusso D, et al. O003/#557 Overall survival results from ARIEL3: a phase 3 randomized, double-blind study of rucaparib vs placebo following response to platinum-based chemotherapy for recurrent ovarian carcinoma. Int J Gynecol Cancer 2022;32:A34.

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