First-line chemotherapy for the treatment of women with epithelial ovarian cancer

Background

In 2010, ovarian cancer was the second most commonly diagnosed gynaecological cancer in Australia, with a total of 1,305 ovarian cancer cases diagnosed. It is the most common cause of gynaecological cancer death, representing over half (56%) of such deaths. The five-year relative survival rate for Australian women with ovarian cancer has increased significantly, from 32.4% in 1982-1987 to 43.3% in 2006-2010.

Most women diagnosed with epithelial ovarian cancer are treated with surgery and chemotherapy with the aim of eliminating detectable disease.  Primary cytoreduction aims to remove as much of the tumour as possible, to allow adjuvant treatment to be more effective.  The Gynecologic Oncology Group (GOG) defines optimal cytoreduction as having residual tumour nodules each measuring 1 cm or less in  maximal diameter, with complete cytoreduction (microscopic disease) being the ideal surgical outcome. Ovarian cancer is surgically staged, based on the extent of the disease, using the guidelines established by FIGO (International Federation of Gynecology and Obstetrics). All women with a suspected or diagnosed gynaecological cancer should have access to a comprehensive multi-disciplinary team led by a gynaecological oncologist to provide high quality management tailored to their needs to achieve the best outcome for each woman. Epithelial ovarian cancer (EOC) is a highly chemosensitive tumour, but most women with advanced EOC initially responding to first-line chemotherapy will eventually relapse.

This guideline represents an update of the 2004 guidelines Clinical practice guidelines for the management of women with epithelial ovarian cancer for first-line chemotherapy for treatment of women with epithelial ovarian cancer. 

A systematic review on first-line chemotherapy for women with epithelial ovarian cancer was undertaken to identify areas requiring revision in relation to the 2004 guideline recommendations. Details on the literature search including research questions are provided in the Summary of evidence and Summary of study results.