This clinical scenario addresses women with advanced fallopian tube carcinoma (FIGO stage III or IV) who are not optimal candidates for primary upfront surgery — either because of high perioperative risk or because complete cytoreduction is unlikely to be achieved.
ASCO guidance recognises that although primary cytoreductive surgery is preferred when optimal debulking is achievable, women with high perioperative risk or a low likelihood of achieving optimal cytoreduction represent a distinct population requiring an alternative initial approach. The structured protocol addresses this population specifically.
The protocol defines a chemotherapy-based strategy for the initial setting. For recurrent disease, targeted antiangiogenic therapy and PARP-inhibitor approaches are among the options addressed — with eligibility and selection dependent on prior treatment history and tumor molecular characteristics. The complete agent selection, sequencing, and eligibility criteria are available in the full protocol.
DOI: 10.1200/JOP.18.00662
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.
Olaparib is approved as a treatment for patients with a germline BRCA mutation who have received at least three prior lines of chemotherapy.
Rucaparib is similarly approved as a treatment after at least two prior lines of chemotherapy but in patients with a germline or a somatic BRCA mutation.
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