Recommendations and practice points

The recommendations are based on the statements of evidence for the use of first-line chemotherapy for women with epithelial ovarian cancer. The level of evidence assigned to recommendations is based on the NHMRC Evidence Intervention Hierarchy (Appendix 1). Practice points are also provided to help guide clinical decisions for the use of first-line chemotherapy for women with epithelial ovarian cancer. Practice points are based on expert opinion when the evidence to make a recommendation is insufficient or where the evidence is outside the scope of the systematic review.

Recommendations to individual patients should be based on their circumstances, the absolute benefits and harms of the treatment, other treatments used, quality of life issues and their personal preferences.  These factors should be discussed with the woman and her family and carer(s), tailored to her preferences for information and decision-making involvement.

The recommendations for the use of first-line chemotherapy for the treatment of women with epithelial ovarian cancer should be considered within a multidisciplinary team setting.

Multidisciplinary care is the best-practice approach to providing evidence-based cancer care.10 Multidisciplinary care is an integrated team-based approach to cancer care where medical and allied health care professionals consider all relevant treatment options and collaboratively develop an individual treatment and care plan for each patient.10

RECOMMENDATION
TUMOURS OF LOW MALIGNANT POTENTIAL
LEVEL OF EVIDENCE11 REFERENCE

Adjuvant chemotherapy is not indicated in patients with tumours of low malignant potential (borderline or proliferating), unless invasive peritoneal implants are histologically confirmed.

II

Siedman and Kurman 200012

 

RECOMMENDATIONS 
EARLY STAGE OVARIAN CANCER (I-IIA)
LEVEL OF EVIDENCE11 REFERENCE

Adjuvant chemotherapy with a platinum compound is recommended for women with high-grade or clear-cell histology as these are known to have a higher recurrence rate.

I

Winter-Roach 201213

Adjuvant chemotherapy is not recommended for patients with comprehensively staged IA or IB well or moderately differentiated tumours, as their risk of relapse is low and the toxicity is not justified.

I

 

Winter-Roach 201213

 

PRACTICE POINT
EARLY STAGE OVARIAN CANCER (I-IIA)
REFERENCE

If comprehensive surgical staging has not been undertaken by a certified gynaecological oncologist, the case should be referred for discussion at a multidisciplinary team meeting, for consideration of the option of surgical staging or chemotherapy.

Winter-Roach 201213

 

RECOMMENDATION
ADVANCED OVARIAN CANCER (IIB-IV) - CHEMOTHERAPY
LEVEL OF EVIDENCE11 REFERENCE

Standard first-line treatment of advanced epithelial ovarian cancer should contain a platinum compound, either in combination or as a single agent, unless specifically contraindicated.

II

OVAR 11/ ICON714
GOG 21815
OVAR 516
OVAR 917
GOG 182/ ICON518
Bolis 201019
OVAR 720
OV 1621
HeCOG22
Lhomme 200823
GOCCNE24
SGCTG25
MITO 226
SCOTROC27
GOG 15828
OVAR 329, 30
HeCOG31
Mouratidou32
OV 1033-35
AOCSG36
Muthuramalingam37
SCOTROC2A38
SCOTROC2B39
Minagawa 200640
Mori 200741
JGOG301442
Fruscio 200843

 

RECOMMENDATION
ADVANCED OVARIAN CANCER (IIB-IV) -SCHEDULING - NEOADJUVANT CHEMOTHERAPY
LEVEL OF EVIDENCE11 REFERENCE

While primary debulking is the usual treatment, neoadjuvant chemotherapy may be considered for selected patients with stage III or IV cancers.

II

Vergote 201044

 

RECOMMENDATION
ADVANCED OVARIAN CANCER (IIB-IV) -SCHEDULING – INTRAPERITONEAL CHEMOTHERAPY
LEVEL OF EVIDENCE11 REFERENCE

Women with stage III ovarian cancer who are optimally debulked at primary surgery should be considered for intraperitoneal (IP) chemotherapy. 

IP chemotherapy should be provided in a centre with appropriate expertise and potential toxicities fully explained.

 

I

Jaaback 201145

Armstrong 200646

 

PRACTICE POINT
ADVANCED OVARIAN CANCER (IIB-IV) – BIOLOGICAL THERAPIES
REFERENCE

Based on data from ICON7, bevacizumab can be considered for first-line treatment of women at high risk (stage IV disease or stage III and >1 cm residual disease), taking into account quality of life issues.   

Perren 201114

 

PRACTICE POINT
SCHEDULING- DOSE DENSE CHEMOTHERAPY
REFERENCE

Dose-dense paclitaxel (where time between the administration of chemotherapy drugs is reduced), in combination with 3-weekly carboplatin, can be considered as an option for first-line treatment of advanced epithelial ovarian cancer.

Katsumata, 200947
Katsumata 201248
Harano 201449

 

PRACTICE POINT
OLDER WOMEN
REFERENCE

Treatment should be considered on an individual basis, and age alone should not be used as a criterion for modifying standard treatment.  Adequate geriatric assessment is important to guide appropriate treatment.

 

Eisenhauer 200750

 

PRACTICE POINT
OBESE PATIENTS
REFERENCE

When treating obese women with epithelial ovarian cancer, clinicians should consider the ASCO guidelines on chemotherapy dosing for obese adult cancer patients. 

http://jco.ascopubs.org/cgi/doi/10.1200/JCO.2011.39.9436

Griggs 201251

 

PRACTICE POINT
CLINICAL TRIALS
REFERENCE

Clinical trials have an unquestioned role in improving treatment for future patients and results of several clinical studies have prompted significant changes in practice. It is appropriate for clinicians to discuss participation in clinical trials with women who have ovarian cancer. 

Robinson 200952

Peppercorn 200453