Ovarian cancer (advanced) - paclitaxel, pegylated liposomal doxorubicin hydrochloride and topotecan (review)

1. Guidance

This guidance applies only to paclitaxel, pegylated liposomal doxorubicin hydrochloride (PLDH) and topotecan.

For the purposes of this guidance, the following definitions are used:

• platinum-sensitive ovarian cancer: disease that responds to first-line platinum-based therapy but relapses 12 months or more after completion of initial platinum-based chemotherapy
• partially platinum-sensitive ovarian cancer: disease that responds to first-line platinum-based therapy but relapses between 6 and 12 months after completion of initial platinum-based chemotherapy
• platinum-resistant ovarian cancer: disease that relapses within 6 months of completion of initial platinum-based chemotherapy
• platinum-refractory ovarian cancer: disease that does not respond to initial platinum-based chemotherapy.

1.1. Paclitaxel in combination with a platinum-based compound (carboplatin or cisplatin) is recommended as an option for the second-line (or subsequent) treatment of women with platinum-sensitive or partially platinum-sensitive advanced ovarian cancer, except in women who are allergic to platinum-based compounds.

1.2. Single-agent paclitaxel is recommended as an option for the second-line (or subsequent) treatment of women with platinum-refractory or platinum-resistant advanced ovarian cancer, and for women who are allergic to platinum-based compounds.

1.3. PLDH is recommended as an option for the second-line (or subsequent) treatment of women with partially platinum-sensitive, platinum-resistant or platinum-refractory advanced ovarian cancer, and for women who are allergic to platinum-based compounds.

1.4. Topotecan is recommended as an option for second-line (or subsequent) treatment only for those women with platinum-refractory or platinum-resistant advanced ovarian cancer, or those who are allergic to platinum-based compounds, for whom PLDH and single-agent paclitaxel are considered inappropriate.

1.5. Within these recommendations, the choice of treatment for second-line (or subsequent) chemotherapy should be made after discussion between the responsible clinician and the patient about the risks and benefits of the options.