The National Comprehensive Cancer Network (NCCN) just published three updated ovarian cancer guidelines. The guidelines are based on research evidence from clinical trials and other studies. They are developed by oncologists from an alliance of twenty-one highly respected cancer centers and are one component of a physician’s treatment recommendations for a patient.
The NCCN guidelines also can affect insurers’ decisions about coverage. Women with ovarian cancer should be aware of the just published changes as they may result in adjustments to insurance coverage. The guideline changes include:
1. Use of bevacizumab (Avastin) for ovarian cancer: An addition of first line use of bevacizumab as a Category 3. Use of the drug in the recurrent setting remained as Category 2A.
2. Use of neoadjuvant chemotherapy (chemotherapy before first surgery) from Category2A to Category 1. This change reflects a growing body of data showing that neoadjuvant chemotherapy is equivalent, if not better for some patients, than having surgery before chemotherapy.
3. Increase in importance of waiting until symptoms occur to start treatment for a recurrence from Category 2B to Category 2A. This change reflects a growing body of data showing that women who begin treatment for recurrence at the time the CA-125 blood test rises do not survive longer than women who wait until symptoms occur to start treatment.
It will be some time before the results of these changes can be determined. The Ovarian Cancer National Alliance will continue to closely monitor the situation and keep you up-to-date.
*** The NCCN guidelines use categories to reference level of evidence and consensus.
• Category 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate.
• Category 2A: Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate.
• Category 2B: Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate.
• Category 3: Based upon any level of evidence there is major NCCN disagreement that the intervention is appropriate.