04/17/2017

NCCN has published updates to the NCCN Guidelines® and the NCCN Compendium® for Ovarian Cancer.

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium^®) for Ovarian Cancer. These NCCN Guidelines® are currently available as Version 1.2017. 

• For patients that present with a suspicious mass and/or ascites or abdominal distention and/or symptoms without a source of malignancy, the primary treatment options have been revised and reorganized by clinical stage. (OV-1)
• Complete Remission and Relapse >6mo After Completing Prior Chemotherapy (OV-6)
• The following imaging recommendation has been added to assess treatment response following platinum-based recurrence therapy for platinum-sensitive disease: “Repeat prior imaging: chest/abdominal/pelvic CT, MRI, PET/CT, or PET."
• Niraparib has been added as a maintenance therapy option for platinum-sensitive disease for consideration if there is a partial or complete response after two or more lines of platinum-based therapy.
• The following has been made the preferred adjuvant therapy option for stage I-IV carcinosarcoma: “Chemotherapy as per epithelial ovarian cancer (See Primary Chemotherapy/Primary Adjuvant Therapy on OV-3).” (LCOH-2)
• Fertility-sparing surgery has been added as an option for select patients with stage IA-IC mucinous carcinoma, if not previously done. (LCOH-4)
• Observation has been added as a category 2B option for consideration for incompletely staged dysgerminoma or grade I immature teratoma, with negative tumor markers and negative imaging. (LCOH-10)
• Principles of Systemic Therapy, Primary Systemic Therapy Regimens (OV-B, 3 of 8)
• The following primary systemic therapy option has been added for stage II-IV epithelial ovarian cancer (including LCOH), Fallopian tube cancer, and primary peritoneal cancer: Carboplatin AUC 5 + pegylated liposomal doxorubicin 30 mg/m² every 4 weeks for 6 cycles. 
• A section has been added for neoadjuvant therapy recommendations for epithelial ovarian cancer (including LCOH), Fallopian tube cancer, and primary peritoneal cancer.
• The following has been added as an adjuvant therapy option for use after neoadjuvant therapy and interval debulking surgery: IV paclitaxel 135 mg/m² over 3 hours on Day 1, IP carboplatin AUC 6 Day 1, IP paclitaxel 60 mg/m² Day 8. (Mackay H, Gallagher CJ, Parulekar WR, et al. OV21/PETROC: A randomized Gynecologic Cancer Intergroup (GCIG) phase II study of intraperitoneal (IP) versus intravenous (IV) chemotherapy following neoadjuvant chemotherapy and optimal debulking surgery in epithelial ovarian cancer (EOC) [abstract]. J Clin Oncol 2016;34: Abstract LBA5503.)
• Principles of Systemic Therapy, Acceptable Recurrence Therapies for Epithelial (including LCOH)/Fallopian Tube/Primary Peritoneal Cancer
• Carboplatin/gemcitabine/bevacizumab has been changed from a category 2B recommendation to a category 2A preferred option for platinum-sensitive disease. (OV-B, 5 of 8)
• Carboplatin/paclitaxel, albumin bound has been added as a preferred option for patients with confirmed taxane hypersensitivity. (OV-B, 5 of 8)
• The following options have been added for mucinous tumors only:
• 5-FU/leucovorin/oxaliplatin ± bevacizumab (category 2B for bevacizumab)
• Capecitabine + oxaliplatin
• Rucaparib has been added as a preferred targeted therapy option for platinum-resistant disease, and as a potentially active targeted therapy option for platinum-sensitive disease. (OV-B, 5&6 of 8)
• Rucaparib is recommended for patients with deleterious germline and/or somatic BRCA mutated (as detected by an FDA-approved test or other validated test performed in a CLIA-approved facility) advanced ovarian cancer who have been treated with two or more lines of chemotherapy.
• Reference: Swisher EM, Lin KK, Oza AM, et al. Rucaparib in relapsed, platinum-sensitive high-grade ovarian carcinoma (ARIEL2 Part 1): an international, multicentre, open-label, phase 2 trial. Lancet Oncol 2017;18:75-87.)
• Carboplatin/paclitaxel/bevacizumab has been added as a potentially active option for platinum-sensitive disease. (OV-B, 6 of 8)

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Compendium^®, the NCCN Biomarkers Compendium^®, the NCCN Chemotherapy Order Templates (NCCN Templates^®), and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.