Neoadjuvant and adjuvant systemic therapy for newly diagnosed stage II, III, or IV epithelial ovary, fallopian tube, or primary peritoneal carcinoma

Guideline Objective

To provide guidance for the use of neoadjuvant and adjuvant systemic therapy in women with newly diagnosed stage II, III, or IV epithelial ovary, fallopian tube, or primary peritoneal carcinoma (EOC).

Patient Population

Women with newly diagnosed stage II, III, or IV EOC

Intended Guideline Users

Gynecologic oncologists, medical oncologists, and other clinicians who are involved in the treatment of the target population in the province of Ontario

Research Questions

• What is the most effective regimen to administer systemic therapy for women with newly diagnosed stage II, III, or IV EOC?
• What is the optimal regimen (dose/schedule/frequency) for women who will receive neoadjuvant therapy before interval cytoreduction?
• What is the optimal regimen (dose/schedule/frequency) for women who will receive adjuvant therapy after primary cytoreduction?
• What is the optimal regimen (dose/schedule/frequency) and most effective mode of administration (i.v. versus i.p.) for optimally debulked women (<1 cm residual disease) who will receive adjuvant therapy?
• Do women with BRCA mutation receiving neoadjuvant or adjuvant therapy have different optimal regimen (dose/schedule/frequency) and outcomes compared with women without BRCA mutation?
• Do women with different histological subtypes (low-grade serous, endometrioid, clear cell, mucinous, undifferentiated/unclassifiable), location subtypes, residues after cytoreduction, or stages receiving neoadjuvant or adjuvant therapy have different optimal regimen (dose/schedule/frequency) and outcomes?