KELIM cited in the recent ASCO guidelines for neo-adjuvant chemotherapy !

2025-02-03

ASCO Guideline Update: Neoadjuvant Chemotherapy in Advanced Ovarian Cancer

The American Society of Clinical Oncology (ASCO), in collaboration with the Society of Gynecologic Oncology, has released an updated clinical guideline to guide the treatment of newly diagnosed stage III-IV epithelial ovarian, fallopian tube, or primary peritoneal cancer. The update reflects recent evidence and shifts in clinical practice, with a focus on the roles of primary cytoreductive surgery (PCS) and neoadjuvant chemotherapy (NACT).

Why the Update?

Treatment strategies for advanced ovarian cancer have evolved significantly in the past decade. Traditionally, PCS was the gold standard, involving extensive surgery followed by chemotherapy. However, increasing evidence supports NACT followed by interval cytoreductive surgery (ICS) as a valid alternative—especially for patients who are not ideal candidates for immediate surgery.

Key Recommendations

1. Initial Assessment Patients suspected of having advanced ovarian cancer should be evaluated by a gynecologic oncologist. Initial workup should include:

Serum CA-125 levels
CT scan of the abdomen, pelvis, and chest
Genetic testing (germline and somatic) at diagnosis

Imaging and laparoscopy may be used to evaluate whether optimal debulking can be achieved. Histologic confirmation of cancer is essential before initiating NACT.

2. Deciding Between PCS and NACT

PCS is recommended for patients who are fit for surgery and likely to achieve complete tumor resection.
NACT is preferred for patients who are unlikely to benefit from PCS due to a high tumor burden or high perioperative risk.
If NACT is chosen, surgery should follow within 4 cycles if there is a favorable response.

3. Chemotherapy Regimens A platinum-taxane doublet remains the recommended chemotherapy for both upfront treatment and NACT. Adding bevacizumab may be considered but hasn’t shown consistent benefits in achieving complete tumor resection.

4. Role of HIPEC Hyperthermic intraperitoneal chemotherapy (HIPEC) during ICS shows promising improvements in overall and disease-free survival in some studies. However, it’s limited to specialized centers and is best for carefully selected patients.

5. Maintenance Therapy Following the completion of chemotherapy, patients should be offered FDA-approved maintenance treatments, such as PARP inhibitors, based on molecular profiling and treatment response.

Evidence Base

The recommendations are supported by a review of 61 studies, including randomized clinical trials like EORTC 55971, CHORUS, SCORPION, and JCOG0602. These studies demonstrated that NACT followed by ICS is non-inferior to PCS in survival outcomes and often associated with fewer surgical complications.

Benefits of NACT

Reduced surgical morbidity and mortality
Better tolerance in older or medically compromised patients
Allows time to optimize comorbid conditions
Improved quality of life metrics in the early post-treatment period

Personalized Approach

Treatment should be tailored based on:

Patient performance status

Tumor biology and location

Likelihood of achieving complete cytoreduction

Genetic test results

Patient preferences and comorbidities

The Bottom Line

This updated ASCO guideline confirms that both PCS and NACT are valid initial treatment options, with the choice depending on individual patient factors and surgical feasibility. Emphasis is placed on multidisciplinary care, evidence-based decisions, and genomic testing to support personalized treatment plans.

For more information, visit:
ASCO Gynecologic Cancer Guidelines