Pan-Asia adapted ESMO Clinical Practice Guideline for the management of patients with newly diagnosed and relapsed epithelial ovarian cancer

Abstract

The European Society for Medical Oncology (ESMO) Clinical Practice Guideline for the diagnosis, treatment and follow-up of patients with newly diagnosed and relapsed epithelial ovarian cancer (EOC), published in 2023, was adapted in July 2024, according to established standard methodology, to produce the Pan-Asian adapted ESMO consensus guideline for the management of Asian patients with EOC. The adapted guideline presented in this manuscript represents the consensus opinions reached by a panel of Asian experts in the treatment of patients with EOC representing the oncological societies of China, Indonesia, India, Japan, Korea, Malaysia, the Philippines, Singapore, Taiwan and Thailand, coordinated by ESMO and the Indian Society of Medical and Pediatric Oncology. Voting was based on scientific evidence and was independent of current treatment practices, drug access restrictions and reimbursement decisions in the represented countries. Drug access and reimbursement across Asia are discussed separately in the manuscript. The Pan-Asian consensus aims to guide the optimisation and harmonisation of management of patients with EOC in Asia, drawing on the evidence provided by both Western and Asian trials. Attention is drawn to the disparity in the drug approvals and reimbursement strategies between countries.

Keywords: ESMO; Pan-Asian; epithelial ovarian cancer; guideline; treatment.

Figure 1

Management of early EOC (FIGO stage I-II). See Supplementary Table S1 of the ESMO CPG for EOC for a summary of the benefit of adjuvant systemic therapy for early EOC (FIGO I-II stage). Purple: algorithm title; orange: surgery; blue: systemic anticancer therapy or their combination; white: other aspects of management and non-treatment aspects; dashed lines: optional therapy. CCC, clear-cell carcinoma; ChT, chemotherapy; CPG, Clinical Practice Guideline; EC, endometrioid carcinoma; EOC, epithelial ovarian cancer; ESMO, European Society for Medical Oncology; FIGO, International Federation of Gynecology and Obstetrics; HGSOC, high-grade serous ovarian carcinoma; LGSOC, low-grade serous ovarian carcinoma; MC, mucinous carcinoma.

Figure 2

Management of advanced EOC (FIGO stage III-IV). Purple: algorithm title; orange: surgery; blue: systemic anticancer therapy or their combination; turquoise: non-systemic anticancer therapies or combination of treatment modalities; white: other aspects of management and non-treatment aspects. AUC, area under the curve; ChT, chemotherapy; CPG, Clinical Practice Guideline; EMA, European Medicines Agency; EOC, epithelial ovarian cancer; ESCAT, ESMO Scale for Clinical Actionability of molecular Targets; ESMO, European Society for Medical Oncology; FDA, Food and Drug Administration; FIGO, International Federation of Gynecology and Obstetrics; HRD, homologous recombination deficiency; MCBS, ESMO-Magnitude of Clinical Benefit Scale; mut, mutation; PARPi, poly (ADP-ribose) polymerase inhibitor; wt, wild type. ^aESMO-MCBS v1.1⁴ was used to calculate scores for therapies/indications approved by the EMA or FDA. The scores have been calculated and validated by the ESMO-MCBS Working Group and reviewed by the authors (https://www.esmo.org/guidelines/esmo-mcbs/esmo-mcbs-evaluation-forms). ^bWeekly ChT with paclitaxel (60 mg/m²)–carboplatin (AUC 2) can be an alternative in frail patients [I, B]. ^cOnly when patients have complete or partial response to platinum or no evidence of disease. For patients without response to platinum, a PARPi is not indicated; these patients can be managed with bevacizumab maintenance if appropriate (mainly stable disease), or with second-line therapy if they have progressive disease (see Figure 3). ^dESCAT scores apply to alterations from genomic-driven analyses only. These scores have been defined by the authors of the ESMO CPG for EOC, assisted if needed by the ESMO Translational Research and Precision Medicine Working Group. See Supplementary Table S3, available at https://doi.org/10.1016/j.esmoop.2025.105125 for more information on ESCAT scores. ^eOption for patients for whom bevacizumab was added to paclitaxel–carboplatin.

Figure 3

Management of recurrent EOC. Purple: algorithm title; orange: surgery; blue: systemic anticancer therapy or their combination; turquoise: non-systemic anticancer therapies or combination of treatment modalities; white: other aspects of management and non-treatment aspects. AGO, Arbeitsgemeinschaft Gynaekologische Onkologie; BSC, best supportive care; EMA, European Medicines Agency; EOC, epithelial ovarian cancer; ESMO, European Society for Medical Oncology; FDA, Food and Drug Administration; FRα, folate receptor α; MCBS, ESMO-Magnitude of Clinical Benefit Scale; mut, mutation; PARPi, poly (ADP-ribose) polymerase inhibitor; PLD, pegylated liposomal doxorubicin; TFIp, treatment-free interval from last platinum. ^aPatient preference and quality of life issues may also suggest that platinum is not the best option. ^bIn patients with platinum intolerance who have relapsed >6 months from previous platinum, the combination of trabectedin and PLD may be recommended [II, C; ESMO-MCBS v1.1 score: 2 for patients with platinum-sensitive disease; EMA approved, not FDA approved]. ^cWeekly paclitaxel, PLD, topotecan or gemcitabine. ^dESMO-MCBS v1.1⁴ was used to calculate scores for therapies/indications approved by the EMA or FDA. The scores have been calculated and validated by the ESMO-MCBS Working Group and reviewed by the authors (https://www.esmo.org/guidelines/esmo-mcbs/esmo-mcbs-evaluation-forms). ^ePaclitaxel, PLD or gemcitabine (carboplatin–gemcitabine–bevacizumab: ESMO-MCBS v1.1 score: 3).^{d f}Until disease progression or next line of treatment is started [I, A]. ^gOlaparib for BRCA1/2-mutated: ESMO-MCBS v1.1 score: 2;^d niraparib regardless of BRCA1/2-mut status: ESMO-MCBS v1.1 score: 3;^d rucaparib regardless of BRCA1/2-mut status: ESMO-MCBS v1.1 score: 3.^d