Consolidation or maintenance systemic therapy for newly diagnosed stage II, III, or IV epithelial ovary, fallopian tube, or primary peritoneal carcinoma

Guideline Objective

To provide guidance for consolidation or maintenance systemic therapy in patients with newly diagnosed stage II, III, or IV epithelial ovary, fallopian tube, or primary peritoneal carcinoma (collectively, EOC).

Patient Population

These recommendations apply to patients with newly diagnosed stage II, III, or IV EOC after first-line therapy with cytoreductive surgery and adjuvant therapy (patients who require neoadjuvant therapy before cytoreductive surgery also qualify for this guideline).

Intended Guideline Users

Intended users of this guideline are gynecologic oncologists, medical oncologists, and other clinicians who are involved in the treatment of the target patients in the province of Ontario.

Research Questions

Does maintenance systemic therapy improve OS, PFS, and patient-reported outcomes, with acceptable adverse effects in the target population? If so, what is the optimal regimen for maintenance therapy (dose/schedule/frequency)?

• In the target population, do patients with BRCA1/2 mutation (somatic or germline mutation) or HRD have different optimal regimens for maintenance therapy and outcomes compared with patients without BRCA mutation or HRD?
• Do patients with different histological subtypes (low-grade serous, endometrioid, clear cell, mucinous, undifferentiated/unclassifiable) or different stages have different optimal regimens for maintenance systemic therapy and outcomes?

The outcomes of OS and PFS were rated as "CRITICAL", and adverse effects and patient-reported outcomes (i.e., QoL) were rated as "IMPORTANT" by the Working Group before the literature was searched. For adverse effects, the Working Group members decided to report Grade 3 or higher of the following seven adverse effects if available because they are relevant to the systemic therapy for patients with ovarian cancer: treatment-related death, anemia, neutropenia/leukopenia, thrombocytopenia, nausea, vomiting, and neuropathy.