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Summary of evidence

The statements of evidence and recommendations about the use of first-line chemotherapy for epithelial ovarian cancer are based on a Cancer Australia systematic review of available evidence published between January 2003 and November 2012.9

This systematic review was undertaken by Cancer Australia to identify any revisions required to recommendations for chemotherapy and ensure currency of the 2004 guidelines. Following consultation with a multidisciplinary working group, it was agreed that the scope of the review would be limited to first-line treatment of epithelial ovarian cancer, given differing treatment modalities and heterogeneous needs of women with recurrent disease.       

A search of the literature published between January 2003 and March 2012 was undertaken using electronic databases. The primary search was limited to randomised controlled trials (RCTs) conducted in humans published in the English language. A supplementary search was conducted to identify articles on subsets of the defined population that have specific chemotherapy requirements; this search was not limited to RCTs and included additional search terms related to the sub-populations. In October 2012 the multidisciplinary working group re-prioritised the other issue of obese patients to be a research question. The new research question was systematically searched for in November 2012.

Overall, 75 articles and two conference abstracts were included in the systematic review. Of the included citations, 35 were phase III (RCTs) addressing the primary research questions, 10 were non-randomised controlled trials included in the sub-group question and six were Cochrane reviews used as primary references.

The systematic review addressed six research questions which were developed with input from the multidisciplinary working group. The questions addressed were:

  1. What is the most effective chemotherapy regimen for first-line adjuvant treatment of epithelial ovarian cancer?
  2. What is the most effective schedule (duration/dose/frequency) for chemotherapy regimens for first-line adjuvant treatment of epithelial ovarian cancer?
  3. What is the most effective mode of administration for chemotherapy regimens for first-line adjuvant treatment of epithelial ovarian cancer?
  4. When is the most effective time to administer chemotherapy for first-line treatment of epithelial ovarian cancer?
  5. Are there subsets of the defined population for first-line adjuvant treatment of epithelial ovarian cancer (such as women with BRCA mutations) that have specific chemotherapy requirements?
  6. What are the specific chemotherapy requirements for women with epithelial ovarian cancer who are obese?

The following topics were considered as additional issues of interest, and although they were not specifically searched for in the systematic review, any information on these topics identified was recorded:

  • Any other women with specific chemotherapy requirements/issues for example rural/remote, Aboriginal and Torres Strait Islander women.
  • Resources specification, for example: resources required for intraperitoneal chemotherapy.
  • Patient selection criteria.

For detailed evidence from studies on the use of first-line chemotherapy for epithelial ovarian cancer refer to the Cancer Australia systematic review9.