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ASCO’s Guidelines on Neoadjuvant Therapy for Ovarian Cancer

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The American Society of Gynecologic Oncology and the American Society of Clinical Oncology have published updated guidelines in regards to the use of chemotherapy prior to surgery (neoadjuvant chemotherapy) among women with advanced ovarian cancer. These results were recently published in the Journal of Clinical Oncology.

The ovaries are two walnut-sized organs located in the pelvis of females. The ovaries store eggs, and produce female hormones

Cancer of the ovary is difficult to detect, and therefore, often in advanced stages upon diagnosis. Researchers continue to evaluate optimal treatment regimens for advanced ovarian cancer, including the timing of chemotherapy and surgical removal of cancer.

Neoadjuvant chemotherapy may be used to shrink the cancer prior to surgical removal, and potentially kill cancer cells that may be circulating through the body immediately. However, one of the most important indicators to an optimal outcome for these patients is the achievement of cytoreductive surgery, in which less than 1 centimeter of cancer at the site of origin remains. Data remains unclear as to whether there is a definite advantage to neoadjuvant chemotherapy in certain stages of ovarian cancer.

Researchers from the American Society of Gynecologic Oncology and the American Society of Clinical Oncology recently convened to review data evaluating different timing of chemotherapy and surgery for the treatment of advanced ovarian cancer.

• Overall, patients with the potential of cytoreductive surgery, in which less than 1 centimeter of the cancer remains following surgery, should be candidates for initial surgery.

• Patients with a high risk of side effects associated with the surgical removal of cancer, or those whose cancer is not able to be surgically removed to less than 1 centimeter of the cancer remaining, may be candidates for neoadjuvant chemotherapy.

• All patients with advanced ovarian cancer “should be evaluated by a gynecologic oncologist prior to initiation of therapy.”
Additional information regarding these updated guidelines can be found here: www.asco.org/NACT-ovarian-guideline and www.asco.org/guidelineswiki.

Reference: Wright L, Bohlke K, Armstrong D, et al. Neoadjuvant Chemotherapy for Newly Diagnosed, Advanced Ovarian Cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline. Journal of Clinical Oncology. 2016;34(28):3460-3473.