Gaillard Stéphanie, Lacchetti Christina, Armstrong Deborah K, Cliby William A, Edelson Mitchell I, Garcia Agustin A, Ghebre Rahel G, Gressel Gregory M, Lesnock Jamie L, Meyer Larissa A, Moore Kathleen N, O'Cearbhaill Roisin E, Olawaiye Alexander B, Salani Ritu, Sparacio Dee, van Driel Willemien J, Tew William P
Johns Hopkins University, Baltimore, MD.
American Society of Clinical Oncology, Alexandria, VA.
J Clin Oncol. 2025 Mar;43(7):868-891. doi: 10.1200/JCO-24-02589. Epub 2025 Jan 22.
To provide updated guidance regarding neoadjuvant chemotherapy (NACT) and primary cytoreductive surgery (PCS) among patients with stage III-IV epithelial ovarian, fallopian tube, or primary peritoneal cancer (epithelial ovarian cancer [EOC]).
A multidisciplinary Expert Panel convened and updated the systematic review.
Sixty-one studies form the evidence base.
Patients with suspected stage III-IV EOC should be evaluated by a gynecologic oncologist, with cancer antigen 125, computed tomography of the abdomen and pelvis, and chest imaging included. All patients with EOC should be offered germline genetic and somatic testing at diagnosis. For patients with newly diagnosed advanced EOC who are fit for surgery and have a high likelihood of achieving complete cytoreduction, PCS is recommended. For patients fit for PCS but deemed unlikely to have complete cytoreduction, NACT is recommended. Patients with newly diagnosed advanced EOC and a high perioperative risk profile should receive NACT. Before NACT, patients should have histologic confirmation of invasive ovarian cancer. For NACT, a platinum-taxane doublet is recommended. Interval cytoreductive surgery (ICS) should be performed after ≤four cycles of NACT for patients with a response to chemotherapy or stable disease. For patients with stage III disease, good performance status, and adequate renal function treated with NACT, hyperthermic intraperitoneal chemotherapy may be offered during ICS. After ICS, chemotherapy should continue to complete a six-cycle treatment plan with the optional addition of bevacizumab. Patients with EOC should be offered US Food and Drug Administration-approved maintenance treatments. Patients with progressive disease on NACT should have diagnosis reconfirmed via tissue biopsy. Patients without previous comprehensive genetic or molecular profiling should be offered testing. Treatment options include alternative chemotherapy regimens, clinical trials, and/or initiation of end-of-life care.Additional information is available at www.asco.org/gynecologic-cancer-guidelines.This guideline has been endorsed by the Society of Gynecologic Oncology.
为Ⅲ - Ⅳ期上皮性卵巢癌、输卵管癌或原发性腹膜癌（上皮性卵巢癌[EOC]）患者的新辅助化疗（NACT）和初次肿瘤细胞减灭术（PCS）提供最新指南。
一个多学科专家小组召开会议并更新了系统评价。
61项研究构成了证据基础。
疑似Ⅲ - Ⅳ期EOC的患者应由妇科肿瘤学家进行评估，评估项目包括癌抗原125、腹部和盆腔计算机断层扫描以及胸部影像学检查。所有EOC患者在诊断时均应接受种系基因和体细胞检测。对于新诊断的晚期EOC患者，若适合手术且实现完全肿瘤细胞减灭的可能性高，推荐进行PCS。对于适合PCS但被认为不太可能实现完全肿瘤细胞减灭的患者，推荐进行NACT。新诊断的晚期EOC且围手术期风险高的患者应接受NACT。在NACT之前，患者应进行侵袭性卵巢癌的组织学确诊。对于NACT，推荐使用铂类 - 紫杉烷双联化疗方案。对于化疗有反应或疾病稳定的患者，应在NACT的≤4个周期后进行间隔性肿瘤细胞减灭术（ICS）。对于接受NACT治疗的Ⅲ期疾病、身体状况良好且肾功能正常的患者，可在ICS期间进行热灌注腹腔化疗。ICS后，化疗应继续完成6个周期的治疗计划，可选择加用贝伐单抗。EOC患者应接受美国食品药品监督管理局批准的维持治疗。NACT期间疾病进展的患者应通过组织活检重新确认诊断。未进行过全面基因或分子检测的患者应接受检测。治疗选择包括替代化疗方案、临床试验和/或开始临终关怀。更多信息可在www.asco.org/gynecologic-cancer-guidelines查询。本指南已得到妇科肿瘤学会的认可。
