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)
