Table 3

Chemotherapy: ovarian cancer

High62 Medium62 Low62
For advanced ovarian cancer, neoadjuvant chemotherapy may be preferred to primary cytoreductive surgery and be effective in delaying surgery and inpatient hospitalization7 14–16 Interval surgery may then follow if local capacity permits, or in some centers clinicians may consider continuing to six cycles to delay surgery7 15 51
Patients should undergo at least two new cycles of chemotherapy after their surgery.15
Test for Breast Cancer Antigen (BRCA) mutations, germline and somatic so that patients may access poly ADP ribose polymerase inhibitors
Poly ADP ribose polymerase inhibitors should be started at the end of chemotherapy, if possible, patients may access Poly ADP ribose polymerase inhibitors before the opportunity for surgery arises7 16
Consider the routine use of Filgrastim (granulocyte colony stimulating factor) to reduce the incidence of neutropenia in patients receiving combination therapy7
Malignant germ cell tumors high priority if requiring chemotherapy49
Chemotherapy for platinum-sensitive relapse should be considered for symptomatic patients and delayed where possible for asymptomatic patients7 16 Chemotherapy for non-serous, non-endometrioid ovarian cancers and low-grade cancers offers limited benefit and adjuvant chemotherapy in these patients is of lower priority Consider hormonal therapy (letrozole, anastrozole, tamoxifen)7 8
Maintenance bevacizumab used with caution as it has low survival benefit and may be associated with a higher risk of bowel perforation7
Following up-front adjuvant chemotherapy; consideration may be given to oral maintenance therapy, such as PARPi, as maintenance intravenous therapy requires repeated visits to the hospital51,16