Advanced Fallopian Tube Carcinoma in Females: What to Do When Neoadjuvant Chemotherapy Did Not Achieve Optimal Cytoreduction
This protocol covers females with advanced (FIGO stage III or IV) fallopian tube carcinoma who were initially identified as having either a high perioperative risk or a low likelihood of achieving optimal surgical debulking, and for whom the neoadjuvant chemotherapy approach did not meet its cytoreductive goal.
Clinical Scenario
The patient is female with advanced-stage (FIGO III or IV) fallopian tube carcinoma. At presentation, primary cytoreductive surgery was not the preferred path due to a high perioperative risk or a low likelihood of achieving optimal debulking. ASCO guidance supports neoadjuvant chemotherapy followed by possible interval surgery for this population.
Previous Treatment Line & Failure Condition
The preceding treatment was neoadjuvant platinum-based chemotherapy — carboplatin and paclitaxel — followed by possible interval cytoreductive surgery. The goal of that approach was optimal debulking, defined as residual disease of 1 cm or less in maximum diameter or thickness. This protocol addresses the next step when that surgical threshold is not met.
Treatment Approach (partial overview)
For platinum-sensitive recurrent disease, the approach involves bevacizumab in combination with platinum-based chemotherapy, followed by bevacizumab maintenance; PARP inhibitor maintenance may additionally be considered for patients who achieve at least a partial response to platinum-based therapy. The full regimen, sequencing, and eligibility criteria are available in the complete protocol.
References
- ASCO states that although primary cytoreductive surgery is preferred for patients with a high likelihood of achieving optimal debulking, women with high perioperative risk or a low likelihood of achieving optimal cytoreduction should receive neoadjuvant chemotherapy followed by possible interval surgery.
- To date, bevacizumab has been FDA approved for the following uses in epithelial ovarian cancer: in combination with carboplatin plus paclitaxel, followed by bevacizumab single agent for stage III or IV disease after initial surgical resection; in combination with paclitaxel, pegylated liposomal doxorubicin, or topotecan for platinum-resistant recurrent epithelial ovarian cancer after no more than two prior chemotherapy regimens; and in combination with carboplatin plus paclitaxel or carboplatin plus gemcitabine, followed by bevacizumab single agent, for platinum-sensitive recurrent epithelial ovarian cancer.
- All three drugs are approved for maintenance treatment of recurrence of epithelial ovarian cancer in patients with at least a partial response to platinum-based therapy.
DOI: 10.1200/JOP.18.00662
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