Systemic Therapy for Recurrent Epithelial Ovarian Cancer: A Clinical Practice Guideline

Objective: The purpose of this guideline is to recommend systemic therapy options for women with recurrent epithelial ovarian cancer, including fallopian tube and primary peritoneal cancers. Methods: This document updates the recommendations published in the 2011 Optimal Chemotherapy for Recurrent Ovarian Cancer guideline from Cancer Care Ontario. Draft recommendations were formulated based on evidence obtained through a systematic review of phase II and III randomized controlled trials (RCTS). The draft recommendations underwent internal review by clinical and methodology experts, and external review by clinical practitioners through a survey assessing the clinical relevance and overall quality of the guideline. Feedback from the internal and external reviews was integrated into the clinical practice guideline. Results: The primary literature search yielded thirty-six primary research papers representing thirty RCTS that met the eligibility criteria. The guideline provides recommendations for patients with serous tumour histologies and with recurrent, platinum-resistant, and platinum-sensitive ovarian cancer. Conclusions: The body of evidence from trials that included olaparib and bevacizumab consistently shows a benefit in progression-free survival (PFS) without a corresponding benefit in overall survival (OS). The Working Group for this guideline designated PFS, which is associated with symptom control, as a critical outcome. A finding of net benefit can therefore be concluded based on significant differences in PFS. However, that benefit is not without identified harms. Given the identified harms, patient involvement in the decision-making process must take into consideration the side effect profiles of olaparib and bevacizumab within the context of improved PFS but minimal change in OS.