Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: ASCO guideline update Guidelines
| Authors: | Gaillard, S.; Lacchetti, C.; Armstrong, D. K.; Cliby, W. A.; Edelson, M. I.; Garcia, A. A.; Ghebre, R. G.; Gressel, G. M.; Lesnock, J. L.; Meyer, L. A.; Moore, K. N.; O'Cearbhaill, R. E.; Olawaiye, A. B.; Salani, R.; Sparacio, D.; Van Driel, W. J.; Tew, W. P. |
| Title: | Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: ASCO guideline update |
| Abstract: | ASCO Guidelines provide recommendations with comprehensive review and analyses of the relevant literature for each recommendation, following the guideline development process as outlined in the ASCO Guidelines Methodology Manual. ASCO Guidelines follow the ASCO Conflict of Interest Policy for Clinical Practice Guidelines.Clinical Practice Guidelines and other guidance ("Guidance") provided by ASCO is not a comprehensive or definitive guide to treatment options. It is intended for voluntary use by clinicians and should be used in conjunction with independent professional judgment. Guidance may not be applicable to all patients, interventions, diseases or stages of diseases. Guidance is based on review and analysis of relevant literature and is not intended as a statement of the standard of care. ASCO does not endorse third-party drugs, devices, services, or therapies and assumes no responsibility for any harm arising from or related to the use of this information. See complete disclaimer in Appendix 1 and 2 (online only) for more.PURPOSETo provide updated guidance regarding neoadjuvant chemotherapy (NACT) and primary cytoreductive surgery (PCS) among patients with stage III-IV epithelial ovarian, fallopian tube, or primary peritoneal cancer (epithelial ovarian cancer [EOC]).METHODSA multidisciplinary Expert Panel convened and updated the systematic review. RESULTSSixty-one studies form the evidence base.RECOMMENDATIONSPatients with suspected stage III-IV EOC should be evaluated by a gynecologic oncologist, with cancer antigen 125, computed tomography of the abdomen and pelvis, and chest imaging included. All patients with EOC should be offered germline genetic and somatic testing at diagnosis. For patients with newly diagnosed advanced EOC who are fit for surgery and have a high likelihood of achieving complete cytoreduction, PCS is recommended. For patients fit for PCS but deemed unlikely to have complete cytoreduction, NACT is recommended. Patients with newly diagnosed advanced EOC and a high perioperative risk profile should receive NACT. Before NACT, patients should have histologic confirmation of invasive ovarian cancer. For NACT, a platinum-Taxane doublet is recommended. Interval cytoreductive surgery (ICS) should be performed after ≤four cycles of NACT for patients with a response to chemotherapy or stable disease. For patients with stage III disease, good performance status, and adequate renal function treated with NACT, hyperthermic intraperitoneal chemotherapy may be offered during ICS. After ICS, chemotherapy should continue to complete a six-cycle treatment plan with the optional addition of bevacizumab. Patients with EOC should be offered US Food and Drug Administration-Approved maintenance treatments. Patients with progressive disease on NACT should have diagnosis reconfirmed via tissue biopsy. Patients without previous comprehensive genetic or molecular profiling should be offered testing. Treatment options include alternative chemotherapy regimens, clinical trials, and/or initiation of end-of-life care.Additional information is available at www.asco.org/gynecologic-cancer-guidelines.This guideline has been endorsed by the Society of Gynecologic Oncology. © American Society of Clinical Oncology. |
| Keywords: | adult; cancer survival; treatment response; histopathology; sorafenib; bevacizumab; cisplatin; doxorubicin; advanced cancer; monotherapy; treatment planning; unspecified side effect; gemcitabine; paclitaxel; chemotherapy, adjuvant; neoadjuvant therapy; topotecan; cancer staging; drug megadose; antineoplastic agent; neoplasm staging; cytoreductive surgery; ovarian neoplasms; quality control; carboplatin; computer assisted tomography; multiple cycle treatment; nephrotoxicity; peritoneum cancer; olanzapine; maintenance therapy; dexamethasone; practice guideline; food and drug administration; pathology; kidney function; systematic review; dosage schedule comparison; adjuvant chemotherapy; ovary tumor; ovary carcinoma; ondansetron; nicotinamide adenine dinucleotide adenosine diphosphate ribosyltransferase inhibitor; interpersonal communication; neoadjuvant chemotherapy; ca 125 antigen; clinical practice guideline; drug therapy; therapy; olaparib; aprepitant; randomized controlled trial (topic); fallopian tube cancer; phase 2 clinical trial (topic); phase 3 clinical trial (topic); palonosetron; multicenter study (topic); tumor invasion; primary cytoreductive surgery; hyperthermic intraperitoneal chemotherapy; sodium thiosulfate; niraparib; humans; human; female; article; multidisciplinary team; cytoreduction surgical procedures; avelumab; health equity; carcinoma, ovarian epithelial; gynecologic oncologist; doublet chemotherapy; equivalence trial (topic) |
| Journal Title: | Journal of Clinical Oncology |
| Volume: | 43 |
| Issue: | 7 |
| ISSN: | 0732-183X |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 2025-03-01 |
| Start Page: | 868 |
| End Page: | 891 |
| Language: | English |
| DOI: | 10.1200/jco-24-02589 |
| PUBMED: | 39841949 |
| PROVIDER: | scopus |
| PMCID: | PMC11934100 |
| DOI/URL: | |
| Notes: | Source: Scopus |
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