Ovarian Cancer

Regimen Options

Last Updated: 04/04/2025 See Details

	Evolent Pathways	Febrile Neutropenic Risk	Emetogenic Risk	References
Neoadjuvant (before surgery) or Adjuvant (after surgery)	cisplatin and paclitaxel	Low	Moderate	NCCN Guidelines® for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer V.4.2017.
	cisplatin and docetaxel	Intermediate	High	NCCN Guidelines® for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer V.4.2017.
	carboplatin and paclitaxel	Low	High	NCCN Guidelines® for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer V.4.2017.
	carboplatin and docetaxel	Intermediate	Moderate	NCCN Guidelines® for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer V.4.2017.
Primary Therapy for Stage II–IV Disease	carboplatin and paclitaxel	Low	High	NCCN Guidelines® for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer V.1.2025. Pignata, S et al. J Clin Oncol. 2011 Sep 20;29(27):3628-35.
Maintenance post primary chemotherapy	niraparib	Low	High	NCCN Guidelines® for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer V.4.2017. González-Martín A et al. N Engl J Med 2019; 381:2391-2402
	olaparib BRCA mutation	Low	Moderate	NCCN Guidelines® for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer v.4.2022. Friedlander M, et al. Lancet Oncol . 2021 May;22(5):632-642.
Recurrence Therapy for Platinum-Sensitive Disease	cisplatin and paclitaxel	Low	High	NCCN Guidelines® for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer V.4.2017. Armstrong DK, et al. N Engl J Med. 2006;354(1):34-43. Brown J, et al. Gynecol Oncol. 2005;97(2):489-96.
	cisplatin and docetaxel	Intermediate	High	NCCN Guidelines® for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer V.4.2017. Diéras V, et al. Cancer Chemother Pharmacol. 2004;53(6):489-95. Markman M, et al. J Clin Oncol. 2001;19(7):1901-5. Katsumata N, et al. Ann Oncol. 2000;11(12):1531-6.
	carboplatin and Doxil (liposomal doxorubicin)	Low	High	NCCN Guidelines® for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer V.4.2017.
	cisplatin and Doxil (liposomal doxorubicin)	Low	High	NCCN Guidelines® for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer V.4.2017.
	cisplatin and gemcitabine	Low	High	NCCN Guidelines® for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer V.4.2017.
Maintenance post recurrence chemotherapy	niraparib BRCA mutation	Low	High	NCCN Guidelines® for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer V.4.2017. ZEJULATM® (niraparib) capsules, package insert. Waltham, MA: TESARO, Inc; 2017, March. FDA Label. Mirza MR et al. N Engl J Med. 2016 Dec 1;375(22):2154-2164
	olaparib BRCA mutation	Low	Moderate	NCCN Guidelines® for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer V.4.2017. LYNPARZA® (olaparib) tablet, package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2018, Jan. FDA Label. Pujade-Lauraine E et al. Lancet Oncol. 2017 Sep;18(9):1274-1284.
Recurrence Therapy for Platinum-Resistant Disease	gemcitabine	Low	Low	NCCN Guidelines® for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer V.4.2017. Ferrandina G, et al. J Clin Oncol. 2008;26(6):890-6. Mutch DG, et al. J Clin Oncol. 2007;25(19):2811-8.
	topotecan	Intermediate	Low	NCCN Guidelines® for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer V.4.2017. Sehouli J, et al. J Clin Oncol. 2011;29(2):242-8. Gordon AN, et al. Gynecol Oncol. 2004;95(1):1-8.
	paclitaxel	Low	Low	NCCN Guidelines® for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer V.4.2017. Parmar MK, et al. Lancet. 2003;361(9375):2099-106. Markman M, et al. Gynecol. Oncol. 2006;101(3):436-40.
	docetaxel	Intermediate	Low	NCCN Guidelines® for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer V.4.2017. Rose PG, et al. Gynecol. Oncol. 2003;88(2):130-5.
	Doxil (liposomal doxorubicin)	Low	Low	NCCN Guidelines® for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer V.4.2017. Ferrandina G, et al. J Clin Oncol. 2008;26(6):890-6. Mutch DG, et al. J Clin Oncol. 2007;25(19):2811-8.
	Best Supportive Care	Not Applicable	Not applicable	NCCN Guidelines® for Supportive Care

Neoadjuvant (before surgery) or Adjuvant (after surgery)

Evolent Pathways

cisplatin and paclitaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Evolent Pathways

cisplatin and docetaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

carboplatin and paclitaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

carboplatin and docetaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

moderate

References

Primary Therapy for Stage II–IV Disease

Evolent Pathways

carboplatin and paclitaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Maintenance post primary chemotherapy

Evolent Pathways

niraparib

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

olaparib *BRCA mutation*

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Recurrence Therapy for Platinum-Sensitive Disease

Evolent Pathways

cisplatin and paclitaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

cisplatin and docetaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

high

References

Evolent Pathways

carboplatin and Doxil (liposomal doxorubicin)

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

cisplatin and Doxil (liposomal doxorubicin)

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

cisplatin and gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Maintenance post recurrence chemotherapy

Evolent Pathways

niraparib *BRCA mutation*

Febrile Neutropenic Risk

low

Emetogenic Risk

high

References

Evolent Pathways

olaparib *BRCA mutation*

Febrile Neutropenic Risk

low

Emetogenic Risk

moderate

References

Recurrence Therapy for Platinum-Resistant Disease

Evolent Pathways

gemcitabine

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

topotecan

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

paclitaxel

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

docetaxel

Febrile Neutropenic Risk

intermediate

Emetogenic Risk

low

References

Evolent Pathways

Doxil (liposomal doxorubicin)

Febrile Neutropenic Risk

low

Emetogenic Risk

low

References

Evolent Pathways

Best Supportive Care

Febrile Neutropenic Risk

Emetogenic Risk

References

	Regimen	Alternative
LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES
Recurrence Therapy	niraparib or olaparib or rucaparib	Alternative: carboplatin + paclitaxel or any other single agent not previously used
	albumin-bound paclitaxel (Abraxane)	Alternative: paclitaxel

LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES

Recurrence Therapy

Regimen

** niraparib or olaparib or rucaparib **

Regimen

** albumin-bound paclitaxel (Abraxane) **

Pathways and Low-Value Regimens

Ovarian Cancer