ASCO and SGO Issue New guidelines for treament of Stage IIIC and IV Epithelial Ovarian Cancers

LorettaMarshall
LorettaMarshall Member Posts: 662 Member
edited August 2016 in Ovarian Cancer #1

 Hello everyone

For all of us that have been diagnosed with some stage of Ovarian Cancer, we naturally hope and pray that some new “breakthrough” will come along that will help us.  But for the time being, although immunotherapy treatments have been shown to be successful for some other types of cancer, there has yet to be one that has definitely been shown to be effective for OC patients.  However, there are clinical trials in the works.  My oncologist has told me that when one has been approved by the FDA that he will definitely give me the choice of having that treatment.  I would welcome that since I’ve already had two separate regimens of Carboplatin and Paclitaxel—a series of 6 treatments 3 weeks apart in 2013 and another regimen of the same chemo in 2015. 

 I thought it would be interesting to share this article with you about “new guidelines” for treating Ovarian Cancer.  So I will just print it below my name exactly as it came in on my e-mail.  As probably many of you, I have many medical alerts come in each day and I just thought I should share this one with you.

 From reading this report, the guideline provides evidence-based recommendations to clinicians on whether to use neoadjuvant chemotherapy or surgery as a first-line treatment for women with stage IIIC and IV epithelial ovarian cancers.

 In my case, when I went to the University of Pittsburgh Medical Center for my SECOND opinion a PET/CT scan revealed both ovaries were cancerous.  Three weeks earlier I had walked into our local ER thinking I might have a hernia.  Two hours later I was handed a CT report that indicated I had Peritoneal Carcinomatosis.  So doctors @ UPMC performed exploratory surgery and concluded that my tumors were too large and too numerous to perform Cytoreductive Surgery (CRS) first.

 Doctors there recommended Neo-adjuvant chemotherapy first.  (Neo-adjuvant means “before” as opposed to “adjuvant” which means after) when speaking of treatments. I see that their recommendations were in line with these guidelines.

 The neo-adjuvant chemo regimen reduced my tumors enough to justify CRS.  While it was never intended to be “curative” for my Stage IV cancer, it served to remove several “non-essential” organs to which the cancer could spread further and has given me a longer survival time than I would have had otherwise.

 So for those diagnosed with Stage IIIC or IV epithelial ovarian cancers, they should discuss these guidelines with their gynecologic oncologist to better understand why one treatment is recommended over another.

 Loretta

 Peritoneal Carcinomatosis/Ovarian Cancer Stage IV

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 1.  http://www.cancertherapyadvisor.com/gynecologic-cancer/ovarian-cancer-asco-sgo-new-guidelines-treatment/article/514573/?DCMP=ILC-

 “Gynecologic Cancer Advisor

 Headlines -- Treatment Regimens -- Drug Information -- Cancer Therapy Advisor > Cancer Topics > Gynecologic Cancer >

 Jason Hoffman, PharmD, RPh -  August 08, 2016

 ASCO and SGO Issue New Guidelines for Treating Ovarian Cancer

 ASCO and the Society of Gynecologic Oncology jointly issued new clinical practice guidelines for the treatment of patients with ovarian cancer.

 The American Society of Clinical Oncology (ASCO) and the Society of Gynecologic Oncology (SGO) jointly issued new clinical practice guidelines for the treatment of patients with ovarian cancer.1

 The guideline, Neoadjuvant Chemotherapy for Newly Diagnosed, Advanced Ovarian Cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline, was published in both the Journal of Clinical Oncology and Gynecologic Oncology.

 The guideline provides evidence-based recommendations to clinicians on whether to use neoadjuvant chemotherapy or surgery as a first-line treatment for women with stage IIIC and IV epithelial ovarian cancers, which account for 70% to 80% of all ovarian cancers. The recommendations are based on 4 phase clinical trials: SCORPION, CHORUS, JCOG0602, and EORTC 55971.

 "This guideline is a big step forward in 1 of the most contentious areas within gynecologic oncology," said Alexi A. Wright, MD, MPH, co-chair and ASCO's representative on the Expert Panel that developed the guideline. "It provides clear recommendations to help patients and physicians make more evidence-based and informed decisions when women are first diagnosed with ovarian cancer."

 Key recommendations of the new guideline include:

 All women with suspected stage IIIC or IV invasive epithelial ovarian cancer should be assessed by a gynecologic oncologist before treatment initiation to determine whether they are candidates for primary cytoreductive surgery.

  • Neoadjuvant chemotherapy should be given to women who have a high perioperative risk profile or a low likelihood of achieving cytoreduction to less than 1 cm (ideally to no visible disease).
  • Women who are fit for primary cytoreductive surgery with potentially resectable disease may receive either primary cytoreductive surgery or neoadjuvant chemotherapy.

Primary cytoreductive surgery is preferred over neoadjuvant chemotherapy for women with a high likelihood of achieving cytoreduction to less than 1 cm (ideally to no visible disease).

    • Neoadjuvant chemotherapy is recommended for women who are fit for primary cytoreductive surgery but are deemed by a gynecologic oncologist as unlikely to have cytoreduction to less than 1 cm (ideally to no visible disease).

 For neoadjuvant chemotherapy, clinicians are advised to treat patients with a doublet regimen consisting of a platinum agent and a taxane, though alternate platinum-containing regimens may be selected for subjective reasons. The Expert Panel notes that it is unclear how weekly dose-dense paclitaxel compares with every-3-week paclitaxel in the preoperative setting.

 Prior to the delivery of chemotherapy, all patients should have histologic confirmation, preferentially by using core biopsy of an invasive ovarian, fallopian tube, or peritoneal cancer. When a core biopsy cannot be performed, cytologic evaluation with a serum CA-125 to carcinoembryonic antigen (CEA) ratio less than 25 can be used to confirm the primary diagnosis, and exclude a non-gynecologic malignancy.

 "This guideline represents an important collaboration between the SGO and ASCO," said Mitchell I. Edelson, MD, co-chair and SGO's representative on the Expert Panel that developed the guideline. "These evidence-based recommendations will improve the quality of care provided to women with ovarian cancer."

 RELATED: Multi-gene Testing Increases Complexity of Counseling Women at Risk of Breast and Ovarian Cancer

 2.  http://www.cancertherapyadvisor.com/breast-cancer/multi-gene-testing-increases-complexity-of-counseling-women-at-risk-of-breast-and-ovarian-cancer/article/507861/

  Future clinical trials conducted in the United States should evaluate the impact of primary cytoreductive surgery versus neoadjuvant chemotherapy on median overall survival, average operative time, and rates of optimal cytoreduction.   

 Reference -  Wright AA, Bohlke K, Armstrong DK, et al. Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical practice guideline. J Clin Oncol. 2016 Aug 8. doi: 10.1200/JCO.2016.68.69907 [Epub ahead of print]”

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