NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Ovarian Cancer

·         For patients with a suspicious palpable mass and/or symptoms, the following primary treatment option has been revised: “Patients with bulky stage III/IV who are poor surgical candidates due to high-risk comorbid conditions or disease factors require evaluation by a gynecologic oncologist for consideration of neoadjuvant chemotherapy (category 1)/primary interval cytoreduction . Tissue diagnosis prior to initiation of chemotherapy is required.” (OV-1)

·         The following primary treatment option for stage II,III,IV/suspected unresectable residual disease has been revised: “Chemotherapy for a total of 6 cycles. Consider completion surgery after 3 cycles followed by postoperative chemotherapy Evaluate for interval debulking surgery prior to fourth cycle of chemotherapy.” (OV-2)

·         A pathway has been added for less common ovarian histologies.  (OV-3)

·         Following complete remission for stage II-IV epithelial ovarian/Fallopian tube/primary peritoneal cancer, the option of postremission paclitaxel has been changed from a “category 3” to a “category 2B” recommendation. (OV-4)

·         Less Common Ovarian Histopathologies

o    The adjuvant treatment options have been expanded for stage I-IV carcinosarcoma. (LCOH-2)

o    Primary treatment recommendations have been added for the following less common histologies:

§  Clear cell carcinoma (LCOH-3)

§  Mucinous carcinoma (LCOH-4)

§  Grade 1 (low-grade) serous/endometrioid epithelial carcinoma (LCOH-5)

o    Borderline Epithelial Tumors (Low Malignant Potential)

§  Following comprehensive or incomplete surgical staging with invasive implants, the option to “consider treatment as epithelial ovarian cancer (category 2B)” has been changed to “consider treatment as grade 1 (low-grade) serous epithelial carcinoma”. (LCOH-6 and LCOH-7)

§  When fertility is desired, the following primary treatment option has been revised: “Fertility-sparing surgery with resection of residual disease .” (LCOH-7)

§  For patients with no invasive implants or unknown, the primary treatment option of observation has been changed from a category 2A to a category 2B recommendation. (LCOH-7)

§  For patients with invasive implants at previous surgery, the primary treatment option of observation has been changed from a category 2B to a category 3 recommendation. (LCOH-7)

·         A new section has been added to the principles of surgery, titled: “Interval cytoreduction after neoadjuvant chemotherapy of invasive epithelial ovarian cancer.” (OV-A, 3 of 4)

·         Primary Chemotherapy/Primary Adjuvant Therapy Regimens (OV-B, 3 of 7)

o    The primary chemotherapy/adjuvant therapy regimens for stage II-IV epithelial ovarian/Fallopian tube/primary peritoneal cancer are also included as options for the following less common histologies: carcinosarcoma, clear cell carcinoma, mucinous carcinoma, grade 1 (low-grade) serous/endometrioid carcinoma, and borderline epithelial tumors.

o    Additional primary therapy options have been included for less common histologies.

·         Acceptable Recurrence Therapies for Epithelial Ovarian/Fallopian Tube/Primary Peritoneal Cancer (OV-B, 5 of 7)

o    Combination paclitaxel (weekly) + pazopanib has been added as a preferred option for platinum-resistant disease.

§  Reference: Pignata S, Lorusso D, Scambia G, et al. Pazopanib plus weekly paclitaxel versus weekly paclitaxel alone for platinum-resistant or platinum-refractory advanced ovarian cancer (MITO 11): a randomised, open-label, phase 2 trial. Lancet Oncol 2015;16:561-568.

o    Single agent pazopanib has been added as a potentially active, single agent targeted therapy option, with a category 2B recommendation.

§  Reference: Friedlander M, Hancock KC, Rischin D, et al. A Phase II, open-label study evaluating pazopanib in patients with recurrent ovarian cancer. Gynecol Oncol 2010;119:32-37.

·         The acceptable cytotoxic recurrence therapy options for malignant germ cell tumors have been divided into potentially curative therapies versus palliative therapies only. (OV-B, 6 of 7)

·         The updated WHO histologic classification table has been included and reproduced with permission from Kurman RJ, Carcangiu ML, Herrington CS, Young RH. World Health Organization Classification of Tumours of the Female Reproductive Organs. IARC, Lyon, 2014. (OV-D)

·         The Discussion section has been updated to reflect the changes in the algorithm. (MS-1)

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

To access the NCCN Biomarkers Compendium^®, please visit NCCN.org/biomarkers.

To view the NCCN Guidelines for Patients^®, please visit NCCN.org/patients.

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