TY - JOUR
T1 - Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer
T2 - Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline
AU - Wright, Alexi A.
AU - Bohlke, Kari
AU - Armstrong, Deborah K.
AU - Bookman, Michael A.
AU - Cliby, William A.
AU - Coleman, Robert L.
AU - Dizon, Don S.
AU - Kash, Joseph J.
AU - Meyer, Larissa A.
AU - Moore, Kathleen N.
AU - Olawaiye, Alexander B.
AU - Oldham, Jessica
AU - Salani, Ritu
AU - Sparacio, Dee
AU - Tew, William P.
AU - Vergote, Ignace
AU - Edelson, Mitchell I.
N1 - Funding Information:
W.P.T. received support through the National Institutes of Health/National Cancer Institute (NIH/NCI) Cancer Center Support Grant P30 CA008748, and A.A.W. received support from the NIH/NCI K07 CA166210 award. Clovis Oncology, AstraZeneca, Eisai (I), Exelixis (I) GamaMabs Pharma AstraZeneca/MedImmune, Esperance Pharmaceuticals, OncoMed, Array BioPharma, Clovis Oncology, Amgen, Johnson and Johnson, Merrimack Aeterna Zentaris AstraZeneca Amgen (Inst), AstraZeneca (Inst), Boehringer Ingelheim (Inst), Bristol-Myers Squibb (Inst), Chugai Pharma (Inst), Eisai (Inst), Exelixis (Inst), Fresenius Biotech (Inst), GlaxoSmithKline (Inst), Proacta (Inst), Ipsen (Inst), Janssen-Cilag (Inst), Merck Sharp and Dohme (Inst), Merrimack (Inst), Morphotek (Inst), Nektar (Inst), Nerviano Medical Sciences (Inst), Novartis (Inst), Pfizer (Inst), Quintiles (Inst), Roche (Inst), Sandoz (Inst), Sanofi (Inst), Schering-Plough (Inst), Vifor Pharma (Inst), Wyeth (Inst) We thank Jason Wright, Christina Annunziata, Neelima Denduluri, Cynthia Anderson, the ASCO Clinical Practice Guidelines Committee, the SGO Publications Committee, and the SGO Clinical Practice Committee for their thoughtful reviews and insightful comments on this guideline document.
Publisher Copyright:
© 2016 Society of Gynecologic Oncology and American Society of Clinical Oncology.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Purpose: To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer. Methods: The Society of Gynecologic Oncology and the American Society of Clinical Oncology convened an Expert Panel and conducted a systematic review of the literature. Results: Four phase III clinical trials form the primary evidence base for the recommendations. The published studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer, neoadjuvant chemotherapy and interval cytoreduction are noninferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioperative morbidity and mortality. Recommendations: All women with suspected stage IIIC or IV invasive epithelial ovarian cancer should be evaluated by a gynecologic oncologist prior to initiation of therapy. The primary clinical evaluation should include a CT of the abdomen and pelvis, and chest imaging (CT preferred). Women with a high perioperative risk profile or a low likelihood of achieving cytoreduction to < 1 cm of residual disease (ideally to no visible disease) should receive neoadjuvant chemotherapy. Women who are fit for primary cytoreductive surgery, and with potentially resectable disease, may receive either neoadjuvant chemotherapy or primary cytoreductive surgery. However, primary cytoreductive surgery is preferred if there is a high likelihood of achieving cytoreduction to < 1 cm (ideally to no visible disease) with acceptable morbidity. Before neoadjuvant chemotherapy is delivered, all patients should have confirmation of an invasive ovarian, fallopian tube, or peritoneal cancer. Additional information is available at www.asco.org/NACT-ovarian-guideline and www.asco.org/guidelineswiki.
AB - Purpose: To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer. Methods: The Society of Gynecologic Oncology and the American Society of Clinical Oncology convened an Expert Panel and conducted a systematic review of the literature. Results: Four phase III clinical trials form the primary evidence base for the recommendations. The published studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer, neoadjuvant chemotherapy and interval cytoreduction are noninferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioperative morbidity and mortality. Recommendations: All women with suspected stage IIIC or IV invasive epithelial ovarian cancer should be evaluated by a gynecologic oncologist prior to initiation of therapy. The primary clinical evaluation should include a CT of the abdomen and pelvis, and chest imaging (CT preferred). Women with a high perioperative risk profile or a low likelihood of achieving cytoreduction to < 1 cm of residual disease (ideally to no visible disease) should receive neoadjuvant chemotherapy. Women who are fit for primary cytoreductive surgery, and with potentially resectable disease, may receive either neoadjuvant chemotherapy or primary cytoreductive surgery. However, primary cytoreductive surgery is preferred if there is a high likelihood of achieving cytoreduction to < 1 cm (ideally to no visible disease) with acceptable morbidity. Before neoadjuvant chemotherapy is delivered, all patients should have confirmation of an invasive ovarian, fallopian tube, or peritoneal cancer. Additional information is available at www.asco.org/NACT-ovarian-guideline and www.asco.org/guidelineswiki.
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U2 - 10.1200/JCO.2016.68.6907
DO - 10.1200/JCO.2016.68.6907
M3 - Article
C2 - 27502591
AN - SCOPUS:84990026588
SN - 0732-183X
VL - 34
SP - 3460
EP - 3473
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 28
ER -