ESMO–ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease

Abstract

These consensus statements were developed by the European Society for Medical Oncology (ESMO) and the European Society of Gynaecological Oncology (ESGO) and are published jointly in the Annals of Oncology and the International Journal of Gynecological Cancer. The two societies nominated participants who attended the consensus conference and co-authored the final manuscript. ‡ See Appendix for members of the ESMO-ESGO Ovarian Cancer Consensus Conference Working Group. The development of guidelines recommendations is one of the core activities of the European Society for Medical Oncology (ESMO) and European Society of Gynaecologial Oncology (ESGO), as part of the mission of both societies to improve the quality of care for patients with cancer across Europe. ESMO and ESGO jointly developed clinically relevant and evidence-based recommendations in several selected areas in order to improve the quality of care for women with ovarian cancer. The ESMO-ESGO consensus conference on ovarian cancer was held on 12-14 April 2018 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of ovarian cancer. Before the conference, the expert panel worked on five clinically relevant questions regarding ovarian cancer relating to each of the following four areas: pathology and molecular biology, early-stage and borderline tumours, advanced stage disease and recurrent disease. Relevant scientific literature, as identified using a systematic search, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. The recommendations presented here are thus based on the best available evidence and expert agreement. This article presents the recommendations of this ESMO-ESGO consensus conference, together with a summary of evidence supporting each recommendation.

Treatment of recurrent epithelial ovarian cancer

“…28 BRCA1 and BRCA2 mutations can be found in approximately 20% of high-grade serous ovarian cancers: they are germline in two-thirds of cases and somatic in the remaining cases. 4 The efficacy of olaparib in BRCA-mutated patients was also prospectively evaluated in the SOLO-2 trial, in which the drug was administered in a new tablet formulation at the dose of 300 mg twice daily. 30 Maintenance with olaparib was the first PARP inhibitor treatment approved in Europe and was initially approved only for patients with mutations of the BRCA1 and BRCA2 genes.…”

“…Rucaparib induced an overall response rate of 54% and a median duration of response of 9.2 months. 4 Targeting angiogenesis is the second option for adding a biological agent to chemotherapy for patients who are candidates to receive platinum therapy at recurrence. The median PFS after rucaparib was 12.8 months for the BRCA-mutated patients and 5.7 and 5.2 months for the LOH-high and LOH-low cohorts, respectively.…”

“…[2][3][4] However, the activity of these platinum combinations in patients with a PFI between 6 and 12 months (partially platinum-sensitive) is controversial. [2][3][4] However, the activity of these platinum combinations in patients with a PFI between 6 and 12 months (partially platinum-sensitive) is controversial.…”

“…1,2 The platinum-free interval (PFI) has been used for years as the main prognostic factor in recurrent disease and as the main parameter for guiding therapeutic decisions. 3,4 Moreover, according to this new concept, patients are now divided into 2 categories: those eligible for platinum rechallenge and those for whom platinum is not considered an option. According to this parameter, patients are divided into defined categories: platinum-refractory (those patients who experience disease recurrence during chemotherapy or within the first 4 weeks after the end of platinum-based chemotherapy) and platinum-resistant (those patients who initially respond and progress less than 6 months after the end of the first-line treatment).…”

Hyperthermic intraperitoneal chemotherapy for ovarian cancer: The heat is on

“…46 Confirmation bias may play a role in the methodological issues raised regarding studies on intraperitoneal chemotherapy in general and the OVHIPEC trial in particular. Meanwhile, other interventions are easily adopted in international guidelines despite the lack of mature comparative data (eg, surgery for recurrent disease).…”