Summary Recommendations

Guideline Recommendations

What is the optimal intravenous (IV) chemotherapy post primary cytoreductive surgery?

Carboplatin is the platinum drug of choice in both single and combination therapy. (A)

Paclitaxel is recommended in combination therapy with platinum in the first line post-surgery treatment of EOC where the potential benefits justify the toxicity of the therapy.

In those unable to tolerate paclitaxel, pegylated liposomal doxorubicin or gemcitabine in combination with carboplatin can be used as an alternative. (A)

Patients who are unfit for combination therapy should be offered single agent carboplatin. (A)

A third cytotoxic agent should not be added to carboplatin and paclitaxel. (A)

Dose-dense Chemotherapy:

Carboplatin AUC 6 (day 1 q21) and paclitaxel 80mg/m2(days 1, 8, 15 q21) may be considered for the treatment of first line ovarian cancer. The increased toxicity and frequency of visits need to be discussed with the patient. (B)

What is the role of intraperitoneal (IP) chemotherapy in optimally debulked advanced EOC?

IP treatment has not been adopted as standard of care in view of its greater toxicity and difficulty delivering all the planned treatment.

Lack of current standard Intravenous chemotherapy in the standard arms of the IP trials has made the interpretation of the results difficult.

Recommends IP chemotherapy in the context of clinical trial.

What is the role of upfront bevacizumab in advanced EOC?

Bevacizumab is recommended for patients with poor prognostic features (as defined in ICON-7 Trial):

- Stage IV

- Suboptimal debulking (I,B)

Bevacizumab should be given with paclitaxel and carboplatin with a treatment duration of 1 year.

Bevacizumab has been licensed by the European Medicines Agency (EMA) at15mg/kg for use with Carboplatin and Paclitaxel for 15 months or until progression.

What is the role of neoadjuvant chemotherapy in advanced EOC?

Consider neoadjuvant chemotherapy / primary interval cytoreduction (diagnosis by fine needle aspiration, biopsy or paracentesis) for patients with bulky stage III/IV who are poor surgical candidates due to high-risk comorbidity conditions or disease factors. (Category 1)

Published data demonstrates that primary assessments and debulking by a gynaecologic oncologist results in a survival advantage. Patients being evaluated for neoadjuvant chemotherapy should be seen by a fellowship-trained gynaecologic oncologist prior to being considered a poor surgical candidate.