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
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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 |
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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 |
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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 |
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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 |
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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 |
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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. |
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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 |
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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. |
Griggs 201251 |
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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 |