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Flash Update: NCCN Guidelines® and NCCN Compendium® for Ovarian Cancer & NCCN Radiation Therapy Compendium™

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Ovarian Cancer. These NCCN Guidelines® are currently available as Version 1.2018.

  • CA 19-9 has been added to the list of other tumor markers to be tested as clinically indicated during the workup for ovarian cancer. (OV-1 and OV-2)
  • Footnote "n" has been revised: Pathologists recommend categorizing serous ovarian cancer as either low grade (most grade 1 serous tumors) or high grade (most grade 2 or 3 serous tumors). Grade 2 serous is considered high grade." (OV-2 and OV-3).
  • Primary Chemotherapy/Primary adjuvant therapy (OV-3)
    • The primary therapy options for stage IA-IB, grade 2 endometrioid tumors have been revised: "Observe or Intravenous (IV) platinum-based therapy taxane/carboplatin x 3–6 cycles (see primary regimens for stage I disease (OV-B, 3 of 10)."
    • The primary therapy recommendation for stage IA-IB, grade 3 and stage IC, grade 1-3 tumors has been revised: "IV platinum-based therapy taxane/carboplatin x 3–6 cycles (see primary regimens for stage I disease (OV-B, 3 of 10)."
    • The following primary therapy option for stage II-IV disease has been revised: "Platinum-based chemotherapy [See Primary Regimens for stage II-IV disease (OV-B, 3 of 10)] Intraperitoneal (IP) chemotherapy in <1 cm optimally debulked stage II and stage III patients (category 1 for stage III, category 2A for stage II and LCOH) or IV taxane/carboplatin for a total of 6 cycles (category 1, category 2A for LCOH)"
  • Stage II-IV, Post Primary Treatment (OV-4)
    • Bevacizumab has been added as a maintenance therapy option if partial or complete remission following systemic therapy with bevacizumab.
    • Pazopanib has been changed from a category 2B to a category 3 maintenance therapy option if complete clinical remission following primary therapy for patients that did not previously receive bevacizumab.
    • Paclitaxel has been removed from the maintenance therapy options if complete clinical remission following primary therapy for patients that did not previously receive bevacizumab.
  • Therapy for Persistent Disease or Recurrence (OV-6)
    • Following complete remission and relapse ≥6 months after completing prior chemotherapy:
      • Continuation of bevacizumab has been added as a maintenance therapy option for patients with a partial or complete response following platinum-based recurrence chemotherapy with bevacizumab.
      • Rucaparib has been added as a maintenance therapy option for consideration for patients with a partial or complete response following 2 or more lines of platinum-based therapy.
    • A category has been added under disease status to clarify the options for patients with progression following recurrence therapy for platinum-sensitive disease. The options include clinical trial and/or best supportive care and/or recurrence therapy.
    • Footnote "aa" has been added: "During and after treatment for recurrence, patients should be evaluated regularly with tumor markers and repeat imaging (with modalities previously used) to document response and/or disease status."
    • The following has been added to footnote "ff": "Discontinue bevacizumab before initiating maintenance therapy with a PARP inhibitor."
  • Clear Cell Carcinoma of the Ovary (LCOH-3)
    • The primary therapy recommendation for stage IA-IC tumors has been revised: "IV platinum-based therapy taxane/carboplatin x 3–6 cycles (see primary regimens for stage I disease (OV-B, 3 of 10)." (Also for stage IC on LCOH-4 and LCOH-5)
  • Mucinous Carcinoma (LCOH-4)
    • 5-FU + leucovorin + oxaliplatin + bevacizumab has been added as a category 2B adjuvant therapy option for stage II-IV disease.
    • Capecitabine + oxaliplatin + bevacizumab has been added as a category 2B adjuvant therapy option for stage II-IV disease.
  • Low-grade Serous/Grade 1 Endometrioid Epithelial Carcinoma (LCOH-5)
    • Exemestane has been added as an aromatase inhibitor option for stage IC-IV disease. This is a category 2B recommendation.
    • Maintenance hormonal therapy (ie, aromatase inhibitors [anastrozole, letrozole, exemestane], leuprolide acetate, tamoxifen) has been added as an option following chemotherapy for stage II-IV disease. This is a category 2B recommendation.
  • The table of surveillance recommendations for malignant germ cell and sex cord-stromal tumors has been updated based on the following reference: Salani R, Khanna N, Frimer M, et al. An update on post-treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncology (SGO) recommendations. Gynecol Oncol 2017;146(1):3-10. (LCOH-12)
  • Primary Systemic Therapy
    • The following IV regimens have been added as options for elderly patients (>age 70) and/or those with comorbidities, if stage I-IV epithelial ovarian cancer (including LCOH)/Fallopian Tube/Primary Peritoneal Cancer (OB-V, 2 of 10):
      • Carboplatin AUC 5 given every 3 wk
      • Paclitaxel 135 mg/m2 + carboplatin AUC 5 given every 3 wk
      • Paclitaxel 60 mg/m2 IV over 1 hour followed by carboplatin AUC 2 IV over 30 minutes. Weekly for 18 wk
    • The following primary systemic therapy options have been added for stage I epithelial ovarian cancer (including LCOH)/Fallopian Tube/Primary Peritoneal Cancer (OV-B, 3 of 10):
      • Paclitaxel 175 mg/m2 IV over 3 hours followed by carboplatin AUC 5–6 IV over 1 hour Day 1. Repeat every 3 weeks x 3–6 cycles. (preferred)
      • Carboplatin AUC 5 + pegylated liposomal doxorubicin 30 mg/m2 every 4 weeks for 3–6 cycles
      • Docetaxel 60–75 mg/m2 IV over 1 hour followed by carboplatin AUC 5–6 IV over 1 hour Day 1. Repeat every 3 weeks x 6 cycles
    • The following regimens have been changed from category 1 to category 2A recommendations for stages II-IV epithelial ovarian cancer (including LCOH)/Fallopian Tube/Primary Peritoneal Cancer:
      • IP/IV Paclitaxel/cisplatin
      • IV Paclitaxel/carboplatin (weekly)
      • IV Dose-dense paclitaxel/carboplatin
      • IV Paclitaxel/carboplatin (every 3 weeks)
      • IV Docetaxel/carboplatin
    • The bevacizumab-containing regimens (paclitaxel/carboplatin/bevacizumab) per ICON-7 and GOG-218 have been changed from category 2B to category 2A recommendations.
    • Under neoadjuvant therapy:
      • The following has been added: "Consider the histology of the primary tumor and the potential response to primary chemotherapy when evaluating for neoadjuvant chemotherapy." (OV-B, 3 of 10)
      • The following has been added to the third bullet: "If bevacizumab is being used as part of a neoadjuvant regimen, bevacizumab should be withheld from therapy for at least 6 weeks prior to interval debulking surgery (IDS)." (OV-B, 3 of 10)
  • Acceptable Recurrence Therapies for Epithelial Ovarian Cancer (including LCOH)/Fallopian Tube/Primary Peritoneal Cancer
    • Carboplatin/paclitaxel/bevacizumab has been moved from the other potentially active recurrence therapies to the list of preferred recurrence therapy options for platinum-sensitive disease. (OV-B, 5 of 10)
    • Carboplatin/paclitaxel has been changed from a category 1 to a category 2A preferred recurrence therapy option. (OV-B, 5 of 10)
    • Carboplatin/liposomal doxorubicin has been changed from a category 1 to a category 2A preferred recurrence therapy option. (OV-B, 5 of 10)
    • A new table has been added for options that are useful in certain circumstances. Some regimens included in this new table were previously included in the lists of "preferred agents" and "other potentially active agents." (OV-B, 7 of 10)
  • Exemestane has been added to the aromatase inhibitor recurrence therapy options for malignant sex cord-stromal tumors. (OV-B, 8 of 10)
  • A table has been added with the maintenance therapy options considered useful in certain circumstances for epithelial ovarian cancer (including LCOH)/Fallopian tube/primary peritoneal cancer. (OV-B, 9 of 10)

NCCN has updated the NCCN Radiation Therapy Compendium™ to reflect recommendations within the following NCCN Guidelines:

  • Anal Carcinoma version 1.2018
  • B-Cell Lymphoma version 2.2018
  • Ovarian Cancer version 1.2018
  • Prostate Cancer version 1.2018

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

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

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