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® NCCN NCCN Guidelines Index Ovarian Cancer TOC Discussion NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines® ) Ovarian Cancer Including Fallopian Tube Cancer and Primary Peritoneal Cancer Version 2.2013 NCCN.org NCCN Guidelines for Patients™ are available at www.nccn.com. Continue Version 2.2013, 06/13/13 © National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. ® NCCN NCCN Guidelines Version 2.2013 Panel Members NCCN Guidelines Index Ovarian Cancer TOC Ovarian Cancer Discussion * Robert J. Morgan, Jr., MD/Chair ‡ * Ardeshir Hakam, MD ¹ * Matthew A. Powell, MD W City of Hope Comprehensive Cancer Center Moffitt Cancer Center Siteman Cancer Center at Barnes- Jewish Hospital and Washington * Ronald D. Alvarez, MD W * Laura J. Havrilesky, MD W University School of Medicine University of Alabama at Birmingham Duke Cancer Institute Comprehensive Cancer Center Steven W. Remmenga, MD W Carolyn Johnston, MD W UNMC Eppley Cancer Center at * Deborah K. Armstrong, MD † University of Michigan The Nebraska Medical Center The Sidney Kimmel Comprehensive Comprehensive Cancer Center Cancer Center at Johns Hopkins Paul Sabbatini, MD †Þ * Shashikant Lele, MD W Memorial Sloan-Kettering Cancer Center Robert A. Burger, MD W Roswell Park Cancer Institute Fox Chase Cancer Center Joseph T. Santoso, MD W Lainie Martin, MD † St. Jude Children’s Research Hospital/ Lee-may Chen, MD W Fox Chase Cancer Center University of Tennessee Cancer Institute UCSF Helen Diller Family Comprehensive Cancer Center * Ursula A. Matulonis, MD † *Julian C. Schink, MD W Dana-Farber/Brigham and Women’s Robert H. Lurie Comprehensive Cancer Larry Copeland, MD W Cancer Center Center of Northwestern University The Ohio State University Comprehensive Cancer Center - James Cancer Hospital David M. O’Malley, MD W *Nelson Teng, MD, PhD W and Solove Research Institute The Ohio State University Comprehensive Stanford Cancer Institute Cancer Center - James Cancer Hospital * Marta Ann Crispens, MD W and Solove Research Institute *Theresa L. Werner, MD †‡ Vanderbilt-Ingram Cancer Center Huntsman Cancer Institute Richard T. Penson, MD, MRCP † at the University of Utah David M. Gershenson, MD W Massachusetts General Hospital The University of Texas Cancer Center MD Anderson Cancer Center NCCN Mary Dwyer, MS Heidi J. Gray, MD W Miranda Hughes, PhD University of Washington Medical Center/ Seattle Cancer Care Alliance W Gynecology oncology ‡ Hematology/Hematology oncology Continue † Medical oncology Þ Internal medicine ¹ Pathology NCCN Guidelines Panel Disclosures * Writing committee member Version 2.2013, 06/13/13 © National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. ® NCCN NCCN Guidelines Index NCCN Guidelines Version 2.2013 Table of Contents Ovarian Cancer TOC Ovarian Cancer Discussion NCCN Ovarian Cancer Panel Members Clinical Trials: NCCN believes that Summary of the Guidelines Updates the best management for any cancer Epithelial Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer: patient is in a clinical trial. Clinical Presentation, Workup, Primary Treatment (OV-1) Participation in clinical trials is Diagnosis by Previous Surgery: Findings and Primary Treatment (OV-2) especially encouraged. Pathologic Staging, Primary Chemotherapy/Primary Adjuvant Therapy (OV-3) To find clinical trials online at NCCN Post-Primary Treatment: Secondary Adjuvant Therapy (OV-4) Member Institutions, click here: Monitoring/Follow-Up, Recurrent Disease (OV-5) nccn.org/clinical_trials/physician.html. Disease Status, Therapy for Persistent Disease or Recurrence (OV-6) NCCN Categories of Evidence and Consensus: All recommendations Borderline Epithelial Ovarian Cancer (Low Malignant Potential): are category 2A unless otherwise Clinical Presentation, Primary Treatment (OV-7) specified. Monitoring/Follow-Up, Recurrent Disease, Recurrence Therapy (OV-9) See NCCN Categories of Evidence and Consensus. Principles of Primary Surgery (OV-A) Principles of Chemotherapy (Ovarian, Fallopian Tube, and Primary Peritoneal Cancer) (OV-B) NCCN Guidelines for Patients™ Management of Drug Reactions (OV-C) Primary Chemotherapy/Primary Adjuvant Therapy Regimens for Stage II-IV (OV-D) are available at www.nccn.com. Acceptable Recurrence Therapies (OV-E) Less Common Ovarian Histopathologies: Staging (ST-1) Clinical Presentation, Workup, Diagnosis (LCOH-1) Malignant Germ Cell Tumors (LCOH-2) Malignant Sex Cord-Stromal Tumors (LCOH-4) Carcinosarcoma (Malignant Mixed Müllerian Tumors) (LCOH-5) Sex Cord-Stromal Tumors - WHO Histologic Classification (LCOH-A) Surveillance for Germ Cell and Sex Cord-Stromal Tumors (LCOH-B) Acceptable Recurrence Therapies (LCOH-C) The NCCN Guidelines® are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The National Comprehensive Cancer Network®® (NCCN ) makes no representations or warranties of any kind regarding their content, use or application and disclaims any responsibility for their application or use in any way. The NCCN Guidelines are copyrighted by National Comprehensive Cancer Network® . All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN. ©2013. Version 2.2013, 06/13/13 © National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. ® NCCN NCCN Guidelines Version 2.2013 Updates NCCN Guidelines Index Ovarian Cancer TOC Ovarian Cancer Discussion Updates to the 1.2013 version of the NCCN Guidelines for Ovarian Cancer from the 1.2013 version include: MS-1 · The discussion section was updated to reflect the changes in the algorithm. Updates to the 1.2013 version of the NCCN Guidelines for Ovarian Cancer from the 3.2012 version include: OV-1 OV-8 · Workup · For primary treatment options that include “comprehensive surgical > “Ultrasound and/or abdominal/pelvic CT” was modified to include “as staging,” the category 2B recommendation was clarified to include “for clinically indicated.” staging.” · Footnote “c” was added: “PET/CT scan may be indicated for · Footnotes: indeterminatelesions if results will alter management .” > Footnote “t” was added: “Observation is a reasonable option regardless of whether fertility is desired.” OV-2 > Footnote “u” was added: “For pathologically proven LMP, lymph node · The finding of “Suspected stage IA or IB, grade 3 stage IC” was modified evaluation may be considered on a case-by-case basis.” as: “...grade 3 or clear cell or stage IC. ” · Footnote was removed: “Clear-cell pathology is grade 3.” OV-A 2 of 3 (Also for OV-3.) · “Procedures that may be considered for optimal surgical cytoreduction” was modified by adding: “appendectomy.” OV-3 · Special circumstances, 1st bullet was modified as: “In Stage I early-stage · Stage 1A or 1B, Grade 3 was modified to include: “or clear cell.” disease...” · Footnote was removed: “The NCCN Ovarian Cancer panel recognizes that data for first-line and maintenance bevacizumab are becoming OV-D available and encourages participation in clinical trials.” (Also for OV-D.) · Number “1” was modified as: “Paclitaxel 135 mg/m2 IV continuous infusion over3or 24 h Day 1; cisplatin 75-100 mg/m2 IP, Day 2 after IV paclitaxel; OV-4 paclitaxel 60 mg/m2 IP Day 8(max BSA 2.0 m2) ...” · For Secondary Adjuvant Therapy, “Clinical trial” was moved to be the · Footnotes: first option. > Footnote “2” was added: “The published randomized trial regimen used IV continuous infusion paclitaxel over 24 h.” OV-6 > Footnote “3” was added: “Due to changes in creatinine methodology, · Disease Status, changes regarding carboplatin dosing can be considered. See FDA > For “Progression, stable, or persistent disease on primary carboplatin dosing statement.” chemotherapy,” the option of “supportive care only” was modified by adding “palliative” and a corresponding link, “See NCCN Guidelines for OV-E Palliative Care.” · Under Cytotoxic therapy, an additional preferred regimen option was added: “Carboplatin/gemcitabine/bevacizumab” as a category 2B recommendation OV-7 with a corresponding footnote, “In patients who have not previously · Clinical presentation and primary treatment of “pelvic mass” was received bevacizumab.” incorporated with “diagnosis of low malignant potential lesion with institutional pathology review.” LCOH-B · A new page was added: “Surveillance for Germ Cell and Sex Cord-Stromal Tumors” and links to this page were added throughout the “Less Common Ovarian Histopathologies” algorithms. Version 2.2013, 06/13/13 © National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. UPDATES ® NCCN Guidelines Version 2.2013 NCCN NCCN Guidelines Index Epithelial Ovarian Cancer/ Fallopian Tube Cancer/ Ovarian Cancer TOC Primary Peritoneal Cancer Discussion CLINICAL WORKUP PRIMARY TREATMENTe,f PRESENTATION Laparotomy/hysterectomy
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