{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T16:08:30Z","timestamp":1770739710208,"version":"3.49.0"},"reference-count":42,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,1,8]],"date-time":"2022-01-08T00:00:00Z","timestamp":1641600000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Background: This study aims to provide guidance for the use of neoadjuvant and adjuvant systemic therapy in women with newly diagnosed stage II\u2013IV epithelial ovary, fallopian tube, or primary peritoneal carcinoma. Methods: EMBASE, MEDLINE, and Cochrane Library were investigated for relevant systematic reviews and phase III trials. Articles focusing on consolidation and maintenance therapies were excluded. Results: For women with potentially resectable disease, primary cytoreductive surgery, followed by six to eight cycles of intravenous three-weekly paclitaxel and carboplatin is recommended. For those with a high-risk profile for primary cytoreductive surgery, neoadjuvant chemotherapy can be an option. Adjuvant chemotherapy with six cycles of dose-dense weekly paclitaxel plus three-weekly carboplatin can be considered for women of Japanese descent. In women with stage III or IV disease, the incorporation of bevacizumab concurrent with paclitaxel and carboplatin is not recommended for use as adjuvant therapy unless bevacizumab is continued as maintenance therapy. Intravenous paclitaxel plus intraperitoneal cisplatin and paclitaxel can be considered for stage III optimally debulked women who did not receive neoadjuvant chemotherapy. However, intraperitoneal administration of chemotherapy with bevacizumab should not be considered as an option for stage II\u2013IV optimally debulked women. Discussion: The recommendations represent a current standard of care that is feasible to implement and valued by both clinicians and patients.<\/jats:p>","DOI":"10.3390\/curroncol29010022","type":"journal-article","created":{"date-parts":[[2022,1,9]],"date-time":"2022-01-09T20:29:26Z","timestamp":1641760166000},"page":"231-242","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Neoadjuvant and Adjuvant Systemic Therapy for Newly Diagnosed Stage II\u2013IV Epithelial Ovary, Fallopian Tube, or Primary Peritoneal Carcinoma: A Practice Guideline"],"prefix":"10.3390","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2888-4146","authenticated-orcid":false,"given":"Hal","family":"Hirte","sequence":"first","affiliation":[{"name":"Juravinski Cancer Centre, Division of Medical Oncology, McMaster University, Hamilton, ON L8V 5C2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7175-2451","authenticated-orcid":false,"given":"Raymond","family":"Poon","sequence":"additional","affiliation":[{"name":"Program in Evidence-Based Care, Ontario Health (Cancer Care Ontario), Department of Oncology, McMaster University, Hamilton, ON L8V 1C3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1210-3758","authenticated-orcid":false,"given":"Xiaomei","family":"Yao","sequence":"additional","affiliation":[{"name":"Program in Evidence-Based Care, Ontario Health (Cancer Care Ontario), Department of Oncology, McMaster University, Hamilton, ON L8V 1C3, Canada"},{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taymaa","family":"May","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Princess Margaret Hospital, University of Toronto, Toronto, ON M5G 2C1, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josee-Lyne","family":"Ethier","sequence":"additional","affiliation":[{"name":"Cancer Centre of Southeastern Ontario, Division of Cancer Care and Epidemiology, Cancer Research Institute, Department of Oncology and Medicine, Queen\u2019s University, Kingston, ON K7L 3N6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauri","family":"Petz","sequence":"additional","affiliation":[{"name":"Independent Researcher, North Bay, ON P1B 8L7, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane","family":"Speakman","sequence":"additional","affiliation":[{"name":"Independent Researcher, Sutton, ON L0E 1R0, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8966-1937","authenticated-orcid":false,"given":"Laurie","family":"Elit","sequence":"additional","affiliation":[{"name":"Juravinski Cancer Centre, Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON L8V 5C2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S161","DOI":"10.1016\/S0020-7292(06)60033-7","article-title":"Carcinoma of the Ovary","volume":"95","author":"Heintz","year":"2006","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"103324","DOI":"10.1016\/j.critrevonc.2021.103324","article-title":"Neoadjuvant and adjuvant systemic therapy for newly diagnosed stage II\u2013IV epithelial ovary, fallopian tube, or primary peritoneal carcinoma: A systematic review","volume":"162","author":"Hirte","year":"2021","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1682","DOI":"10.1093\/jnci\/djh323","article-title":"Phase III randomized trial of docetaxel-carboplatin versus paclitaxel-carboplatin as first-line chemotherapy for ovarian carcinoma","volume":"96","author":"Vasey","year":"2004","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.3390\/curroncol28020107","article-title":"An Ontario Health (Cancer Care Ontario) Clinical Practice Guideline: Consolidation or Maintenance Systemic Therapy for Newly Diagnosed Stage II, III, or IV Epithelial Ovary, Fallopian Tube, or Primary Peritoneal Carcinoma","volume":"28","author":"Hirte","year":"2021","journal-title":"Curr. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1200\/JCO.18.01568","article-title":"Randomized Trial of Intravenous Versus Intraperitoneal Chemotherapy Plus Bevacizumab in Advanced Ovarian Carcinoma: An NRG Oncology\/Gynecologic Oncology Group Study","volume":"37","author":"Walker","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1056\/NEJMoa1708618","article-title":"Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer","volume":"378","author":"Koole","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3628","DOI":"10.1200\/JCO.2010.33.8566","article-title":"Carboplatin plus paclitaxel versus carboplatin plus pegylated liposomal doxorubicin as first-line treatment for patients with ovarian cancer: The MITO-2 randomized phase III trial","volume":"29","author":"Pignata","year":"2011","journal-title":"J. Clin. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1056\/NEJMoa052985","article-title":"Intraperitoneal cisplatin and paclitaxel in ovarian cancer","volume":"354","author":"Armstrong","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1038\/bjc.2013.70","article-title":"BRCA1 expression and improved survival in ovarian cancer patients treated with intraperitoneal cisplatin and paclitaxel: A Gynecologic Oncology Group Study","volume":"108","author":"Lesnock","year":"2013","journal-title":"Br. J. Cancer"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.ejca.2020.02.020","article-title":"Comparison of survival between primary debulking surgery and neoadjuvant chemotherapy for stage III\/IV ovarian, tubal and peritoneal cancers in phase III randomised trial","volume":"130","author":"Onda","year":"2020","journal-title":"Eur. J. Cancer"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1093\/jnci\/djq362","article-title":"Advanced ovarian cancer: Phase III randomized study of sequential cisplatin-topotecan and carboplatin-paclitaxel vs carboplatin-paclitaxel","volume":"102","author":"Hoskins","year":"2010","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1200\/JCO.2008.19.1684","article-title":"Evaluation of new platinum-based treatment regimens in advanced-stage ovarian cancer: A phase III trial of the gynecologic cancer intergroup","volume":"27","author":"Bookman","year":"2009","journal-title":"J. Clin. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2613","DOI":"10.1093\/annonc\/mds060","article-title":"First-line treatment of advanced ovarian cancer with paclitaxel\/carboplatin with or without epirubicin (TEC versus TC)-a gynecologic cancer intergroup study of the NSGO, EORTC GCG and NCIC CTG","volume":"23","author":"Lindemann","year":"2012","journal-title":"Ann. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1056\/NEJMoa0908806","article-title":"Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer","volume":"363","author":"Vergote","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/j.ygyno.2013.08.014","article-title":"Quality of life of advanced ovarian cancer patients in the randomized phase III study comparing primary debulking surgery versus neo-adjuvant chemotherapy","volume":"131","author":"Greimel","year":"2013","journal-title":"Gynecol. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S0140-6736(14)62223-6","article-title":"Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): An open-label, randomised, controlled, non-inferiority trial","volume":"386","author":"Kehoe","year":"2015","journal-title":"Lancet"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.ejca.2016.05.017","article-title":"Comparison of treatment invasiveness between upfront debulking surgery versus interval debulking surgery following neoadjuvant chemotherapy for stage III\/IV ovarian, tubal, and peritoneal cancers in a phase III randomised trial: Japan Clinical Oncology Group Study JCOG0602","volume":"64","author":"Onda","year":"2016","journal-title":"Eur. J. Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1136\/ijgc-2020-001640","article-title":"Randomized trial of primary debulking surgery versus neoadjuvant chemotherapy for advanced epithelial ovarian cancer (SCORPION-NCT01461850)","volume":"30","author":"Fagotti","year":"2020","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.ejca.2016.01.017","article-title":"Phase III randomised clinical trial comparing primary surgery versus neoadjuvant chemotherapy in advanced epithelial ovarian cancer with high tumour load (SCORPION trial): Final analysis of peri-operative outcome","volume":"59","author":"Fagotti","year":"2016","journal-title":"Eur. J. Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1093\/annonc\/mdi223","article-title":"Paclitaxel plus carboplatin versus paclitaxel plus alternating carboplatin and cisplatin for initial treatment of advanced ovarian cancer: Long-term efficacy results: A Hellenic Cooperative Oncology Group (HeCOG) study","volume":"16","author":"Aravantinos","year":"2005","journal-title":"Ann. Oncol."},{"key":"ref_21","first-page":"3646","article-title":"Paclitaxel plus nedaplatin vs. paclitaxel plus carboplatin in women with epithelial ovarian cancer: A multi-center, randomized, open-label, phase III trial","volume":"15","author":"Li","year":"2018","journal-title":"Oncol. Lett."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1056\/NEJMoa1505067","article-title":"Weekly vs. every-3-week paclitaxel and carboplatin for ovarian cancer","volume":"374","author":"Chan","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1016\/S1470-2045(13)70363-2","article-title":"Long-term results of dose-dense paclitaxel and carboplatin versus conventional paclitaxel and carboplatin for treatment of advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer (JGOG 3016): A randomised, controlled, open-label trial","volume":"14","author":"Katsumata","year":"2013","journal-title":"Lancet Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2084","DOI":"10.1016\/S0140-6736(19)32259-7","article-title":"Weekly dose-dense chemotherapy in first-line epithelial ovarian, fallopian tube, or primary peritoneal carcinoma treatment (ICON8): Primary progression free survival analysis results from a GCIG phase 3 randomised controlled trial","volume":"394","author":"Clamp","year":"2019","journal-title":"Lancet"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1016\/S0140-6736(09)61157-0","article-title":"Dose-dense paclitaxel once a week in combination with carboplatin every 3 weeks for advanced ovarian cancer: A phase 3, open-label, randomised controlled trial","volume":"374","author":"Katsumata","year":"2009","journal-title":"Lancet"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1093\/annonc\/mdt527","article-title":"Quality-of-life outcomes from a randomized phase III trial of dose-dense weekly paclitaxel and carboplatin compared with conventional paclitaxel and carboplatin as a first-line treatment for stage II-IV ovarian cancer: Japanese Gynecologic Oncology Group trial (JGOG3016)","volume":"25","author":"Harano","year":"2014","journal-title":"Ann. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1016\/S1470-2045(20)30218-7","article-title":"Weekly platinum-based chemotherapy versus 3-weekly platinum-based chemotherapy for newly diagnosed ovarian cancer (ICON8): Quality-of-life results of a phase 3, randomised, controlled trial","volume":"21","author":"Blagden","year":"2020","journal-title":"Lancet Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/S1470-2045(14)70049-X","article-title":"Carboplatin plus paclitaxel once a week versus every 3 weeks in patients with advanced ovarian cancer (MITO-7): A randomised, multicentre, open-label, phase 3 trial","volume":"15","author":"Pignata","year":"2014","journal-title":"Lancet Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2169","DOI":"10.1016\/j.ejca.2008.06.035","article-title":"Carboplatin and Paclitaxel versus Cisplatin, Paclitaxel and Doxorubicin for first-line chemotherapy of Advanced Ovarian Cancer: A Hellenic Cooperative Oncology Group (HeCOG) study","volume":"44","author":"Aravantinos","year":"2008","journal-title":"Eur. J. Cancer"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1200\/JCO.2005.03.2938","article-title":"Addition of epirubicin as a third drug to carboplatin-paclitaxel in first-line treatment of advanced ovarian cancer: A prospectively randomized Gynecologic Cancer Intergroup trial by the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group and the Groupe d\u2019Investigateurs Nationaux pour l\u2019Etude des Cancers Ovariens","volume":"24","author":"Weber","year":"2006","journal-title":"J. Clin. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"4162","DOI":"10.1200\/JCO.2009.27.4696","article-title":"Phase III trial of carboplatin plus paclitaxel with or without gemcitabine in first-line treatment of epithelial ovarian cancer","volume":"28","author":"Herrstedt","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2905","DOI":"10.1016\/j.ejca.2010.06.124","article-title":"Paclitaxel\/carboplatin versus topotecan\/paclitaxel\/carboplatin in patients with FIGO suboptimally resected stage III-IV epithelial ovarian cancer a multicenter, randomized study","volume":"46","author":"Bolis","year":"2010","journal-title":"Eur. J. Cancer"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2317","DOI":"10.1200\/JCO.19.01009","article-title":"Final Overall Survival of a Randomized Trial of Bevacizumab for Primary Treatment of Ovarian Cancer","volume":"37","author":"Tewari","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/j.ygyno.2012.11.038","article-title":"Patient reported outcomes of a randomized, placebo-controlled trial of bevacizumab in the front-line treatment of ovarian cancer: A Gynecologic Oncology Group Study","volume":"128","author":"Monk","year":"2013","journal-title":"Gynecol. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2473","DOI":"10.1056\/NEJMoa1104390","article-title":"Incorporation of bevacizumab in the primary treatment of ovarian cancer","volume":"365","author":"Burger","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.ygyno.2018.08.036","article-title":"Exploratory outcome analyses according to stage and\/or residual disease in the ICON7 trial of carboplatin and paclitaxel with or without bevacizumab for newly diagnosed ovarian cancer","volume":"152","author":"Oza","year":"2019","journal-title":"Gynecol. Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1016\/S1470-2045(15)00086-8","article-title":"Standard chemotherapy with or without bevacizumab for women with newly diagnosed ovarian cancer (ICON7): Overall survival results of a phase 3 randomised trial","volume":"16","author":"Oza","year":"2015","journal-title":"Lancet Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2484","DOI":"10.1056\/NEJMoa1103799","article-title":"A Phase 3 Trial of Bevacizumab in Ovarian Cancer","volume":"365","author":"Perren","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2403","DOI":"10.1056\/NEJMoa1909707","article-title":"Veliparib with First-Line Chemotherapy and as Maintenance Therapy in Ovarian Cancer","volume":"381","author":"Coleman","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1200\/JCO.2006.07.3494","article-title":"Health-related quality of life during and after intraperitoneal versus intravenous chemotherapy for optimally debulked ovarian cancer: A Gynecologic Oncology Group study","volume":"25","author":"Wenzel","year":"2007","journal-title":"J. Clin. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"114","DOI":"10.14694\/EdBook_AM.2015.35.114","article-title":"Chemotherapy for Patients with BRCA1 and BRCA2-Mutated Ovarian Cancer: Same or Different?","volume":"35","author":"Tan","year":"2015","journal-title":"Am. Soc. Clin. Oncol. Educ. Book"},{"key":"ref_42","unstructured":"WHO Classification of Tumours Editorial Board (2020). Female Genital Tumours: WHO Classification of Tumours, IARC. [5th ed.]."}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/29\/1\/22\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:27:00Z","timestamp":1760362020000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/29\/1\/22"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,8]]},"references-count":42,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["curroncol29010022"],"URL":"https:\/\/doi.org\/10.3390\/curroncol29010022","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,8]]}}}