Ovarian Cancer Clinical Practice Guidelines (NCCN, 2022)

National Comprehensive Cancer Network

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

September 29, 2022

Updated guidelines on the diagnosis and treatment of ovarian cancer were published on September 10, 2022 by the National Comprehensive Cancer Network in the Journal of the National Comprehensive Cancer Network.[1]

Treatment options for elderly patients (age >70 years) and/or those with comorbidities are as follows:

  • Intravenous (IV) paclitaxel, 135 mg/m2 plus IV carboplatin, area under the curve (AUC) 5 given every 21 days for 3 to 6 cycles, depending on stage and cancer subtype

  • IV paclitaxel, 60 mg/m2, followed by intravenous carboplatin, AUC 2 on days 1, 8, and 15, repeated every 21 days for 6 cycles

The latter option can also be considered for patients with poor performance status. Single-agent carboplatin is no longer recommended for this patient population.

In patients with low-grade serous carcinoma (LGSC), recommendations for adjuvant treatment are stratified by stage, as follows:

  • Stage IA and IB - Postoperative observation

  • Stage IC or stage II–IV - Several adjuvant systemic therapy options are recommended, including paclitaxel/platinum-containing regimens

Patients with LGSC may also benefit from maintenance hormone therapy following adjuvant chemotherapy.

Patients with LGSC should be monitored for potential recurrence through follow-up visits every 2 to 4 months for 2 years, followed by 3 to 6 months for 3 years, and then annually after 5 years. Monitoring should consist of a physical examination, including a pelvic examination; tumor molecular testing, if not previously done; and imaging and complete blood cell count/chemistry profile.

Treatment options for patients with recurrent LGSC are as follows:

  • Secondary cytoreduction can be considered for patients with a long disease-free interval, isolated masses rather than diffuse carcinomatosis on imaging, and/or bowel obstruction.

  • Recommended systemic therapies include chemotherapy (if not previously used) and hormonal therapy. However, there is no standard sequencing of drugs for recurrent disease, so patients should be evaluated on an individual basis. Options include the MEK inhibitors trametinib and binimetinib and, for patients with a BRAF V600E mutation, dabrafenib plus trametinib.

In patients with ovarian, fallopian tube, or primary peritoneal cancers, tumor testing for select biomarkers is recommended in the up-front and recurrence settings, to identify molecular alterations that can inform the use of interventions such as PARP inhibitors. Biomarker testing should include BRCA1/2 status, loss of heterozygosity, or (in the absence of a germline BRCA mutation) homologous recombination status.

For more information, please go to Ovarian Cancer.

For more Clinical Practice Guidelines, please go to Guidelines.


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