Controversies Continue in NCCN Ovarian Cancer Guidelines

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National Comprehensive Cancer Network (NCCN) 17th Annual Conference

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Controversies Continue in NCCN Ovarian Cancer Guidelines

Neoadjuvant Chemotherapy and CA-125 Reviewed

March 20, 2012 (Hollywood, Florida) — The ovarian cancer guidelines from the National Comprehensive Cancer Network (NCCN) address a number of ongoing controversies, according to a presenter here at the NCCN 17th Annual Conference.

 

"There have not been a lot of changes in the past year, but there are various areas of controversy in the guidelines," Robert Morgan, MD, from the City of Hope Comprehensive Cancer Center in Los Angeles, California, told Medscape Medical News at the conference.
One such controversy is about the usefulness of the biomarker CA-125 to monitor patients who have been treated with surgery and/or chemotherapy. Dr. Morgan called CA-125 the "most controversial" aspect of patient follow-up.......

abstract: Role of Neoadjuvant Chemotherapy in the Management of Stage IIIC-IV Ovarian Cancer: Survey Results from the Members of the European Society of Gynecological Oncology

Int J Gynecol Cancer. 2012 Mar;22(3):407-16.

Abstract

OBJECTIVE:

The aim of this study is to evaluate the current opinion of the members of the European Society of Gynecological Oncology (ESGO) on the use of neoadjuvant chemotherapy (NACT) in stage IIIC and IV ovarian cancer.

METHODS:

A link to a 21-item questionnaire, with questions about the management of patients with stage IIIC and IV ovarian cancer, was sent 3 times to the ESGO members (N = 1177).

Systemic chemotherapy--before (neoadjuvant) or after radical surgery in treatment of patients with advanced ovarian carcinoma?

[18F]FDG-PET/CT monitoring early identifies advanced ovarian cancer patients who will benefit from prolonged neo-adjuvant chemotherapy.

Abstract

AIM: The most accepted standard duration of neoadjuvant chemotherapy (na-CHT) before debulking surgery for advanced ovarian cancer (AOC) is 3 courses. However a percentage of patients could benefit from additional courses......

Surgery or Chemo First in Advanced Ovarian Cancer? New Data Fuel Debate

Medical News:video (Dr Coleman) Similar Survival with Two Ovarian Cancer Strategies - in Oncology/Hematology, Ovarian Cancer from MedPage Today

"Patients with bulky, advanced ovarian cancer survived just as long whether treated with neoadjuvant chemotherapy and surgery or with primary surgery followed by adjuvant chemotherapy, investigators in a multinational trial reported."

"Subgroup analysis failed to identify any patient or tumor characteristics associated with better outcomes with one treatment strategy or the other. In both treatment groups, the success of cytoreductive surgery was the strongest predictor of survival."

Action Points

* Explain to interested patients that according to a recent randomized study, patients with bulky, advanced ovarian cancer survived just as long whether treated with neoadjuvant chemotherapy and surgery or with primary surgery followed by adjuvant chemotherapy


* Explain that both treatment strategies led to a median overall survival of about 30 months and median progression-free survival of 12 months.


Original Article
Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer - NEJM

he role of neoadjuvant chemotherapy in the management of patients with advanced stage ovarian cancer: Survey results from members of the SGO (Society of Gynecologic Oncologists)