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NCCN Releases Updated Guidelines for Ovarian Cancer


At the National Comprehensive Cancer Network Annual Conference in March, Robert J. Morgan, MD, of City of Hope Comprehensive Cancer Center and chair of the NCCN Guidelines Panel for Ovarian Cancer, discussed the future of ovarian cancer and notable changes to the recently updated NCCN Clinical Practice Guidelines in Oncology™ for Ovarian Cancer.

New to the Guidelines is a section on the management of allergic reactions in women receiving chemotherapy for ovarian cancer. Dr. Morgan explained the need for this section as ovarian cancer tends to respond to the same treatment repeatedly. Combined with the fact that recurrence rates of ovarian cancer are high, this can result in women often being re-treated with the same chemotherapeutic agent. Given that virtually all chemotherapy drugs have the potential to cause infusion reactions, including agents commonly used in ovarian cancer, the NCCN Guidelines Panel felt it was important to provide information on allergic reactions and recommendations on desensitization regimens.

“Most patients experiencing allergic reactions are able to be desensitized, allowing for continued chemotherapeutic treatment, which is vital to the management of ovarian cancer,” said Dr. Morgan.

Also new to the Guidelines is the addition of new agents for recurrence therapy, most notably pemetrexed (Alimta®), as well as recommendations for therapies based on the timing of recurrence.

“Seventy-five to 80 percent of patients with stage III or IV ovarian cancer will experience recurrence and this recurrence can occur at any time – during treatment, within six months of completing treatment, or more than a year after completing treatment,” Dr. Morgan noted. “In the updated NCCN Guidelines, we differentiated appropriate therapy for recurrence based upon the time frame on which it occurs.”

Dr. Morgan described updates to the Principles of Primary Surgery section in the Guidelines, which included the recommendation to consider completion surgery for women responsive to chemotherapy with initially unresectable residual disease, as well as recommendations relating to special circumstances, including minimally-invasive procedures and fertility sparing procedures.

Another addition is a section on the Principles of Chemotherapy, which emphasizes the encouragement of women participating in clinical trials during all aspects of their treatment course. It also notes that women with newly diagnosed tumors should be informed about the different options available and the risks and benefits of each regimen.

He concluded that steady progress is being made in the treatment of ovarian cancer, but further trials are necessary.

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This article was published in Coping® with Cancer magazine, May/June 2009.