NICE technology appraisal guidance
Issued: May 2005
TA91

Paclitaxel, pegylated liposomal doxorubicin hydrochloride and topotecan for second-line or subsequent treatment of advanced ovarian cancer: Review of Technology Appraisal Guidance 28, 45 and 55

This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/ta91

1 Guidance

This guidance will replace the following guidance issued by the Institute:

  • 'Ovarian cancer – topotecan' (NICE Technology Appraisal Guidance 28) 2001

  • 'Ovarian cancer (advanced) – pegylated liposomal doxorubicin hydrochloride' (NICE Technology Appraisal Guidance 45) 2002

This guidance replaces recommendations 1.3, 1.4 and 1.5 on the second-line treatment of advanced ovarian cancer in the following guidance:

For details, see 'About this guidance'

This guidance applies only to paclitaxel, pegylated liposomal doxorubicin hydrochloride (PLDH) and topotecan.

For the purposes of this guidance, the following definitions are used:

  • platinum-sensitive ovarian cancer: disease that responds to first-line platinum-based therapy but relapses 12 months or more after completion of initial platinum-based chemotherapy

  • partially platinum-sensitive ovarian cancer: disease that responds to first-line platinum-based therapy but relapses between 6 and 12 months after completion of initial platinum-based chemotherapy

  • platinum-resistant ovarian cancer: disease that relapses within 6 months of completion of initial platinum-based chemotherapy

  • platinum-refractory ovarian cancer: disease that does not respond to initial platinum-based chemotherapy.

1.1 Paclitaxel in combination with a platinum-based compound (carboplatin or cisplatin) is recommended as an option for the second-line (or subsequent) treatment of women with platinum-sensitive or partially platinum-sensitive advanced ovarian cancer, except in women who are allergic to platinum-based compounds.

1.2 Single-agent paclitaxel is recommended as an option for the second-line (or subsequent) treatment of women with platinum-refractory or platinum-resistant advanced ovarian cancer, and for women who are allergic to platinum-based compounds.

1.3 PLDH is recommended as an option for the second-line (or subsequent) treatment of women with partially platinum-sensitive, platinum-resistant or platinum-refractory advanced ovarian cancer, and for women who are allergic to platinum-based compounds.

1.4 Topotecan is recommended as an option for second-line (or subsequent) treatment only for those women with platinum-refractory or platinum-resistant advanced ovarian cancer, or those who are allergic to platinum-based compounds, for whom PLDH and single-agent paclitaxel are considered inappropriate.

1.5 Within these recommendations, the choice of treatment for second-line (or subsequent) chemotherapy should be made after discussion between the responsible clinician and the patient about the risks and benefits of the options.