Fifth Ovarian Cancer Consensus Conference of the Gynecologic Cancer InterGroup: first-line interventions

Abstract

The consensus statements regarding first-line therapies in women with ovarian cancer, reached at the Fifth Ovarian Cancer Consensus Conference held in Tokyo, Japan, in November 2015 are reported. Three topics were reviewed and the following statements are recommended: (i) Surgery: the subgroups that should be considered in first-line ovarian cancer clinical trials should be (a) patients undergoing primary debulking surgery and (b) patients receiving neo-adjuvant chemotherapy. The amount of residual disease following surgery should further stratify patients into those with absent gross residual disease and others. (ii) Control arms for chemotherapy: for advanced stage ovarian cancer the standard is intravenous 3-weekly carboplatin and paclitaxel. Acceptable alternatives, which should be stratified variables in trials when more than one regimen is offered, include weekly paclitaxel plus 3-weekly carboplatin, the addition of bevacizumab to 3-weekly carboplatin and paclitaxel, and intraperitoneal therapy. (iii) Trial Endpoints: overall survival is the preferred primary endpoint for first-line clinical trials with or without a maintenance component. Progression-free survival (PFS) is an alternative primary endpoint, but if PFS is chosen overall survival must be measured as a secondary endpoint and PFS must be supported by additional endpoints, including predefined patient reported outcomes and time to first or second subsequent therapy. For neoadjuvant therapy, additional 'window of opportunity' endpoints should be included.

Epithelial ovarian cancer: Evolution of management in the era of precision medicine

“…9 During this time, well-conducted clinical trials have established important principles that guide therapy internationally, shape the direction of clinical research, and benchmark international consensus recommendations, which have been published by the Gynecologic Cancer Inter Group (GCIG). [10][11][12] These fundamental principles emphasize the importance of surgery by a gynecologic oncologist with reduction of tumor bulk to no residual disease (R0) whenever possible, a pathologic diagnosis defining the subtype of ovarian cancer, and the appropriate systemic treatment based on tumor and patient characteristics with potential access to maintenance therapy. Each of these topics is discussed below, but it is important to ensure that these fundamental principles of good treatment are followed for all women with ovarian cancer.…”

Serum calretinin as an independent predictor for platinum resistance and prognosis in ovarian cancer

“…At primary diagnosis, more than 70% of ovarian cancer patients present with advanced disease . Standard treatment of advanced ovarian cancer consists of primary radical debulking surgery aiming at macroscopic complete tumor resection followed by platinum‐ and paclitaxel‐based chemotherapy, which extends progression‐free survival (PFS) and overall survival (OS) . Postoperative residual tumor burden is one of the most important prognostic factors in advanced ovarian cancer .…”

Efficacy and safety results from GEICO 1205, a randomized phase II trial of neoadjuvant chemotherapy with or without bevacizumab for advanced epithelial ovarian cancer

“…In advanced epithelial ovarian cancer, standard therapy is cytoreductive surgery and chemotherapy (with or without bevacizumab) 1. Neoadjuvant chemotherapy before interval debulking surgery shows similar efficacy to primary debulking surgery followed by chemotherapy when the disease is not considered completely resectable, and may improve tolerability and quality of life compared with primary surgery 2–5.…”