ASCO GUIDELINES Bundle

Advanced Ovarian Cancer

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Treatment Î Before NACT is delivered, all patients should have histologic confirmation (core biopsy preferred) of an invasive ovarian, fallopian tube, or peritoneal cancer. In exceptional cases, when a biopsy cannot be performed, cytologic evaluation combined with a serum CA-125 to carcinoembryonic antigen (CEA) ratio >25 is acceptable to confirm the primary diagnosis and exclude cancers that are not ovarian, fallopian tube, or primary peritoneal carcinomas. (Moderate recommendation; IC-B-I) Î For NACT, a platinum/taxane doublet is recommended. (Moderate recommendation; EB-B-I) • However, alternate regimens, containing a platinum agent, may be selected based on individual patient factors. Î RCTs tested surgery following three or four cycles of chemotherapy in women who had a response to NACT or stable disease. Interval cytoreductive surgery should be performed after ≤4 cycles of NACT for women with a response to chemotherapy or stable disease. (Weak recommendation; IC-B-I) • Alternate timing of surgery has not been prospectively evaluated but may be considered based on patient-centered factors. Î Patients with progressive disease on NACT have a poor prognosis. Options include alternative chemotherapy regimens, clinical trials, and/ or discontinuation of active cancer therapy and initiation of end-of-life care. In general, there is little role for surgery and it is not typically advised, unless for palliation (eg, relief of a bowel obstruction). (Strong recommendation; EB-B-I)

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