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Optimal Adjuvant and/or Systemic Therapy
➤ Clinicians should document pathology and stage to determine
eligibility for adjuvant chemotherapy. If pathology confirmation is not
possible due to patient or resource limitation, alternatives can be
discussed.
➤ Clinicians should not administer (systemic treatment) adjuvant
chemotherapy to patients with ovarian low malignant potential (LMP)
tumors or early-stage micro-invasive borderline tumors, independent
of stage.
➤ Combination chemotherapy with paclitaxel and carboplatin is the
standard of care for adjuvant therapy in ovarian cancer.
➤ Single-agent carboplatin may be used because of resource limitation
or patient characteristics.
➤ Only in enhanced settings, highly selected cases can be assessed
for appropriate evidence-based intraperitoneal chemotherapy (IP),
following optimal debulking, where there are resources and expertise
to manage toxicities.
Optimal Treatment for Recurrent Epithelial Ovarian Cancer
➤ For recurrent disease in limited or enhanced settings only, patients
with recurrent ovarian cancer should be counseled on treatment
options based on a patient's prior response to platinum-based
chemotherapy, that is, platinum-sensitive, platinum-resistant, or
platinum-refractory disease status. Platinum rechallenge is only
recommended for patients with platinum-sensitive disease.
➤ In enhanced settings only, clinicians may offer maintenance systemic
therapies.
➤ Treatment is NOT recommended for patients with tumor marker-
positive (CA-125) only recurrent ovarian cancer.
➤ Early palliative care interventions benefit all patients diagnosed with
ovarian cancer.
General statement about heritable risk:
For women with strong family history of breast and/or ovarian cancer,
clinicians should discuss family history and refer to counseling or testing, if
available.
