scholarly journals Neoadjuvant and Adjuvant Systemic Therapy for Newly Diagnosed Stage II–IV Epithelial Ovary, Fallopian Tube, or Primary Peritoneal Carcinoma: A Practice Guideline

2022 ◽  
Vol 29 (1) ◽  
pp. 231-242
Author(s):  
Hal Hirte ◽  
Raymond Poon ◽  
Xiaomei Yao ◽  
Taymaa May ◽  
Josee-Lyne Ethier ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Fallopian Tube ◽  
Cytoreductive Surgery ◽  
Systemic Therapy ◽  
Stage Ii ◽  
Adjuvant Systemic Therapy ◽  
Stage Iii ◽  
Newly Diagnosed ◽  
Peritoneal Carcinoma ◽  
Primary Peritoneal Carcinoma

Background: This study aims to provide guidance for the use of neoadjuvant and adjuvant systemic therapy in women with newly diagnosed stage II–IV epithelial ovary, fallopian tube, or primary peritoneal carcinoma. Methods: EMBASE, MEDLINE, and Cochrane Library were investigated for relevant systematic reviews and phase III trials. Articles focusing on consolidation and maintenance therapies were excluded. Results: For women with potentially resectable disease, primary cytoreductive surgery, followed by six to eight cycles of intravenous three-weekly paclitaxel and carboplatin is recommended. For those with a high-risk profile for primary cytoreductive surgery, neoadjuvant chemotherapy can be an option. Adjuvant chemotherapy with six cycles of dose-dense weekly paclitaxel plus three-weekly carboplatin can be considered for women of Japanese descent. In women with stage III or IV disease, the incorporation of bevacizumab concurrent with paclitaxel and carboplatin is not recommended for use as adjuvant therapy unless bevacizumab is continued as maintenance therapy. Intravenous paclitaxel plus intraperitoneal cisplatin and paclitaxel can be considered for stage III optimally debulked women who did not receive neoadjuvant chemotherapy. However, intraperitoneal administration of chemotherapy with bevacizumab should not be considered as an option for stage II–IV optimally debulked women. Discussion: The recommendations represent a current standard of care that is feasible to implement and valued by both clinicians and patients.

scholarly journals An Ontario Health (Cancer Care Ontario) Clinical Practice Guideline: Consolidation or Maintenance Systemic Therapy for Newly Diagnosed Stage II, III, or IV Epithelial Ovary, Fallopian Tube, or Primary Peritoneal Carcinoma

2021 ◽  
Vol 28 (2) ◽  
pp. 1114-1124
Author(s):  
Hal Hirte ◽  
Xiaomei Yao ◽  
Sarah E. Ferguson ◽  
Taymaa May ◽  
Laurie Elit
Keyword(s):  
Maintenance Therapy ◽  
Fallopian Tube ◽  
Systemic Therapy ◽  
Stage Ii ◽  
Consolidation Therapy ◽  
Newly Diagnosed ◽  
Peritoneal Carcinoma ◽  
Primary Peritoneal Carcinoma ◽  
Histological Types ◽  
Weak Recommendation

Objective: To provide recommendations on systemic therapy options in consolidation or maintenance therapy for women with newly diagnosed stage II, III, or IV epithelial ovary, fallopian tube, or primary peritoneal carcinoma including all histological types. Methods: Consistent with the Program in Evidence-based Program’s standardized approach, MEDLINE, EMBASE, PubMed, Cochrane Library, and PROSPERO (the international prospective register of systematic reviews) databases, and four relevant conferences were systematically searched. The Working Group drafted recommendations and revised them based on the comments from internal and external reviewers. Results: We have one recommendation for consolidation therapy and eight recommendations for maintenance therapy. Overall, consolidation therapy with chemotherapy should not be recommended in the target population. For maintenance therapy, we recommended olaparib (Recommendation), niraparib (Weak Recommendation), veliparib (Weak Recommendation), and bevacizumab (Weak Recommendation) for certain patients with newly diagnosed stage III–IV epithelial ovarian, fallopian tube, or primary peritoneal carcinoma, respectively. We do not recommend some agents as maintenance therapy in four recommendations. We are unable to specify the patient population by histological types for different maintenance therapy recommendations. When new evidence that can impact the recommendations is available, the recommendations will be updated as soon as possible.

scholarly journals Indications for hyperthermic intraperitoneal chemotherapy with cytoreductive surgery: a clinical practice guideline

2020 ◽  
Vol 27 (3) ◽  
Author(s):  
R.C. Auer ◽  
D. Sivajohanathan ◽  
J. Biagi ◽  
J. Conner ◽  
E. Kennedy ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Peritoneal Carcinomatosis ◽  
Standard Of Care ◽  
Evidence Based ◽  
Research Protocol ◽  
Newly Diagnosed ◽  
Insufficient Evidence ◽  
Peritoneal Carcinoma ◽  
Ongoing Research ◽  
Primary Peritoneal Carcinoma

ObjectiveThe purpose of this present review was to provide evidence-based guidance regarding the provision of CRS with HIPEC in the treatment of peritoneal cancers. MethodsThe guideline was developed by Cancer Care Ontario’s Program in Evidence-Based Care, together with the Surgical Oncology Program, through a systematic review of relevant literature, patient and caregiver-specific consultation and internal and external reviews. Recommendation 1aFor patients with newly diagnosed, primary stage III epithelial ovarian, fallopian tube, or primary peritoneal carcinoma, HIPEC should be considered for those with at least stable disease following neoadjuvant chemotherapy at the time of interval CRS if complete or optimal cytoreduction is achieved. Recommendation 1bThere is insufficient evidence to recommend the addition of HIPEC when primary CRS is performed for patients with newly diagnosed, primary advanced epithelial ovarian, fallopian tube, or primary peritoneal carcinoma outside of a clinical trial. Recommendation 2There is insufficient evidence to recommend HIPEC with CRS in patients with recurrent ovarian cancer outside the context of a clinical trial. Recommendation 3There is insufficient evidence to recommend HIPEC with CRS in patients with peritoneal colorectal carcinomatosis outside of a clinical trial. Recommendation 4There is insufficient evidence to recommend HIPEC with CRS for the prevention of peritoneal carcinomatosis in CRC outside of a clinical trial; however HIPEC using oxaliplatin is not recommended.Recommendation 5There is insufficient evidence to recommend HIPEC with CRS for the treatment of gastric peritoneal carcinomatosis outside of a clinical trial. Recommendation 6There is insufficient evidence to recommend HIPEC with CRS for the prevention of gastric peritoneal carcinomatosis outside of a clinical trial. Recommendation 7There is insufficient evidence to recommend HIPEC with CRS in patients with malignant peritoneal mesothelioma as a standard of care; however, patients should be referred to HIPEC specialty centres for assessment for treatment as part of an ongoing research protocol. Recommendation 8There is insufficient evidence to recommend HIPEC with CRS in patients with disseminated mucinous neoplasm in the appendix as a standard of care; however, patients should be referred to HIPEC specialty centres for assessment for treatment as part of an ongoing research protocol.

TRUST: Trial of Radical Upfront Surgical Therapy in advanced ovarian cancer (ENGOT ov33/AGO‐OVAR OP7)

2019 ◽  
Vol 29 (8) ◽  
pp. 1327-1331 ◽  
Author(s):  
Alexander Reuss ◽  
Andreas du Bois ◽  
Philipp Harter ◽  
Christina Fotopoulou ◽  
Jalid Sehouli ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Cytoreductive Surgery ◽  
Advanced Ovarian Cancer ◽  
Figo Stage ◽  
Complete Resection ◽  
Peritoneal Carcinoma ◽  
Exclusion Criteria ◽  
Platinum Based Chemotherapy

BackgroundPrimary cytoreductive surgery followed by chemotherapy has been considered standard management for patients with advanced ovarian cancer over decades. An alternative approach of interval debulking surgery following neoadjuvant chemotherapy was subsequently reported by two randomized phase III trials (EORTC‐GCG, CHORUS), which were criticized owing to important limitations, especially regarding the rate of complete resection.Primary ObjectiveTo clarify the optimal timing of surgical therapy in advanced ovarian cancer.Study HypothesisPrimary cytoreductive surgery is superior to interval cytoreductive surgery following neoadjuvant chemotherapy for overall survival in patients with advanced ovarian cancer.Trial DesignTRUST is an international open, randomized, controlled multi-center trial investigating overall survival after primary cytoreductive surgery versus neoadjuvant chemotherapy and subsequent interval cytoreductive surgery in patients with FIGO stage IIIB–IVB ovarian, tubal, and peritoneal carcinoma. To guarantee adequate surgical quality, participating centers need to fulfill specific quality assurance criteria (eg, ≥50% complete resection rate in upfront surgery for FIGO IIIB–IVB patients, ≥36 debulking-surgeries/year) and agree to independent audits by TRUST quality committee delegates. Patients in the primary cytoreductive surgery arm undergo surgery followed by 6 cycles of platinum-based chemotherapy, whereas patients in the interval cytoreductive surgery arm undergo 3 cycles of neoadjuvant chemotherapy after histologic confirmation of the disease, followed by interval cytoreductive surgery and subsequently, 3 cycles of platinum-based chemotherapy. The intention of surgery for both groups is complete tumor resection according to guideline recommendations.Major Inclusion/Exclusion CriteriaMajor inclusion criteria are suspected or histologically confirmed, newly diagnosed invasive epithelial ovarian cancer, fallopian tube carcinoma, or primary peritoneal carcinoma FIGO stage IIIB–IVB (IV only if resectable metastasis). Major exclusion criteria are non-epithelial ovarian malignancies and borderline tumors; prior chemotherapy for ovarian cancer; or abdominal/pelvic radiotherapy.Primary EndpointOverall survival.Sample Size772 patients.Estimated Dates for Completing Accrual and Presenting ResultsAccrual completion approximately mid-2019, results are expected after 5 years' follow-up in 2024.Trial RegistrationNCT02828618.

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