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## Complete Summary

#### GUIDELINE TITLE

Use of systemic therapy in women with recurrent ovarian cancer --
development, methods and clinical practice guideline.

#### BIBLIOGRAPHIC SOURCE(S)

Elit L, Zitzelsberger L, Fung-Kee-Fung M, Brouwers M, Graham ID, Browman
G, Hoskins P, Lau S, Ghatage P, Society of Gynecologic Oncologists of
Canada (GOC). Use of systematic therapy in women with recurrent ovarian
cancer - development, methods and clinical practice guideline. Ottawa
(ON): Society of Gynecologic Oncologists of Canada (GOC); 2006 Oct.
Various p. \[21 references\]

#### GUIDELINE STATUS

This is the current release of the guideline.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Recurrent epithelial ovarian cancer

#### GUIDELINE CATEGORY

Management\
Treatment

#### CLINICAL SPECIALTY

Obstetrics and Gynecology\
Oncology\
Pharmacology\
Radiology

#### INTENDED USERS

Health Care Providers\
Pharmacists\
Physicians\
Public Health Departments

#### GUIDELINE OBJECTIVE(S)

To provide guidance for physicians in Canada who treat women with
ovarian cancer, i.e., gynecologic oncologists and medical oncologists

#### TARGET POPULATION

Women with recurrent epithelial ovarian cancer, including
platinum-sensitive, platinum-resistant, and platinum-refractory women

#### INTERVENTIONS AND PRACTICES CONSIDERED

1.  Participation in clinical trials

2.  Platinum-sensitive disease

    -   Retreatment with platinum based combination or monotherapy

    -   Other single-agent therapy (following platin toxicity)

3.  Platinum-resistant disease

    -   Non-platinum-based therapy: etoposide, gemcitabine, liposomal
        doxorubicin, taxanes, topotecan, vinorelbine

4.  Platinum-refractory disease

    -   If patient progresses while on platinum analogue, switch to
        different drug or symptom management alone

5.  Decision to stop chemotherapy

    -   Implementation of best supportive care, including  appropriate
        pain relief

#### MAJOR OUTCOMES CONSIDERED

-   Response rate

-   Drug toxicities

-   Quality of life

-   Survival (overall and progression free)

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Secondary Sources)\
Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

The methods team was given suggestions by the organizing committee on
existing guidelines. Two were identified: a draft Cancer Care Ontario
(CCO) guideline and a Scottish International Guidelines Network (SIGN)
guideline. The methods team also searched MEDLINE, the World Wide Web
(using Google), the Canadian Coordinating Office on Health Technological
Assessment website, the Cochrane Collaboration website, guideline
clearinghouses (National Guideline Clearinghouse, Canadian Medical
Association, Guidelines International Network), known guideline
developers\' websites (e.g., National Institute of Clinical Excellence
UK; Centre for Reviews and Dissemination UK; Ministry of Health
Singapore; World Health Organization; Standards, Options and
Recommendations France; New Zealand Guidelines Group, National Health
and Medical Research Council Australia; Society of Gynecologic
Oncologists USA, Agency for Health Research and Quality USA; Department
of Defense USA) as well as references of published guidelines for
guidelines on recurrent ovarian cancer. The terms used for MEDLINE
searches were purposefully broad: practice guidelines, reviews,
standards, consensus, and ovarian neoplasms. Those used for the WWW
search included ovarian cancer, recurrent ovarian cancer, practice
guidelines, and clinical practice guidelines. The following inclusion
and exclusion criteria were used: only guidelines that were dated from
1995--2005 and published in English or French were considered.
Guidelines without references and those authored by a single individual
(not on behalf of a group) were not considered.

Four guidelines were retrieved. The CCO draft guideline was the only
guideline that specifically concerned recurrent ovarian cancer. The SIGN
guideline included a section on recurrent ovarian cancer within a larger
guideline on ovarian cancer management. The BC Cancer Agency management
protocol for ovarian cancer was included as it is a widely used
protocol. The National Health and Medical Research Council (Australia)
guideline included a small section on recurrence. Panel members were
also provided with the following supporting documents: an National
Cancer Institute Physician Data Query (USA) with a section on
recurrence, a National Institute on Clinical Excellence (UK) document on
Paclitaxel, Pegylated Liposomal Doxorubicin Hydrochloride and Topotecan
for second-line or subsequent treatment, and two care paths (National
Comprehensive Cancer Network, U.S.A. and MD Anderson Cancer Center,
U.S.A.).

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Expert Consensus

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review with Evidence Tables

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

**Guideline Assessment---Quality and Content**

Panel members were asked to appraise guidelines using the AGREE
(Appraisal of Guidelines for Research and Evaluation) instrument
([www.agreetrust.org](http://www.agreetrust.org/)), and review all other
supporting documentation. They were given two weeks to appraise the
guidelines and return their AGREE scores to the resource team. As well,
an assessment of currency of retrieved guidelines was undertaken by the
methods team.

Scores were returned by six panel members. Scores for the dimensions of
the AGREE instrument ranged from 41 to 98% for the Cancer Care Ontario
(CCO) guideline, from 57 to 81% for the Scottish International
Guidelines Network (SIGN) guideline, from 17 to 36% for British Colombia
(BC) Cancer Agency management protocol, and from 33 to 75% for the
National Health and Medical Research Council (NHMRC) guideline (see
Figure A1 in the original guideline document). With respect to overall
assessment, the CCO guideline was most strongly recommended, followed by
the SIGN guideline (see Table A1 in the original guideline document).

As well, an assessment of currency of retrieved guidelines was
undertaken by the methods team. Guideline currency was not an issue with
respect to the clinical practice guidelines reviewed by panel members.
The CCO guideline is still in draft format, and the BC Cancer Agency
management protocol is a living document. The status of both the SIGN
and NHMRC guidelines is listed as \"current\" on their respective
websites. The SIGN guideline was published in October 2003, and the
National Health and Medical Research Council guideline was published in
2004.

**Preparation of the Recommendations Matrix**

In order to easily identify similarities and differences in individual
guideline recommendations, the methods team compiled the recommendations
from each of the guidelines into a Recommendations Matrix (see Table A2
in the original guideline document). Where possible, the level of
evidence associated with a particular recommendation was provided;
otherwise this information was left blank.

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

In order to facilitate the process of guideline adaptation, the Society
of Gynecologic Oncologists of Canada (GOC) chose to use a guideline
adaptation process developed by the Canadian Strategy for Cancer Control
(CSCC) Clinical Practice Guidelines Action Group (CPG-AG) in conjunction
with leading researchers in the field of guideline adaptation. The
following describes the process followed by the panel in deriving
guidance on systemic therapy for women with recurrent ovarian cancer.

**Composition of the Multidisciplinary Panel**

The adaptation/adoption process took part in two phases. A larger group
met initially to begin the process, and a smaller sub-panel followed the
progress made by the larger group through to completion of the
guideline.

The initial multidisciplinary panel invited to participate in the
adaptation process was organized by the Society of Gynecologic
Oncologists of Canada. The panel was populated with representation from
and partnership with the Clinical Practice Guidelines Action Group of
the Canadian Strategy for Cancer Control; Gynecology Oncology Guideline
Panels from provincial cancer agencies such as Ontario (Program in
Evidence-based Care), Quebec, BC; the Society of Obstetricians and
Gynaecologists of Canada; and gynecological oncologists from British
Columbia, Alberta, Manitoba, Ontario, Québec, New Brunswick and
Newfoundland. Members represented experts in the clinical, research,
methodological, and knowledge translation arenas. Fourteen clinical
specialists and four methodologists were involved in the meeting.

All of the members involved on the smaller sub-group had also
participated in the initial process with the exception of one oncologist
who was added to represent the experience of practitioners in Quebec.
Members of the sub-group were selected to be representative of regional
diversity across Canada. With the exception of one physician (a medical
oncologist), the remainder were gynecologic oncologists. In total, six
clinical specialists and one methodologist were involved in the
completion of the guideline.

**Customization of Guidelines for Local Use**

*Initial Panel Meeting -- March 2005*

The panel members convened for a half day workshop. The Appraisal of
Guidelines for Research and Evaluation (AGREE) scores for each of the
six dimensions by guideline were presented in a graphical format. As
well, the overall assessment scores were compiled into a table allowing
comparison between Clinical Practice Guidelines (CPGs). While the AGREE
scores provided panel members with a sense of quality of development as
reported in the guidelines, discussion focused mainly on the individual
recommendations from the guidelines. As the panel felt they could not
adopt any one guideline in its entirety, the discussion followed the
topics as presented in the recommendations matrices, beginning with
general statements, platinum sensitive disease and moving through to
platinum resistant disease.

At the end of the meeting, a list of tentative recommendations was
drafted, and a decision made that a smaller sub-panel would meet to
further discuss and refine potential recommendations.

*Second Panel Meeting -- December 2005*

A teleconference meeting of the sub-group was convened nine months after
the initial meeting. A quick search had been conducted prior to the call
to identify any possible new guidelines, systematic reviews, or health
technology assessments that had been published during the preceding nine
months. The National Institute for Health and Clinical Excellence (NICE)
health technology assessment which was a draft document at the time of
the initial meeting had since been officially published. Otherwise no
new documents were found.

Six physicians and one methodologist were involved in the second
meeting. One of the oncologists who had not been involved in the initial
process, however, had read all the documentation and appraised the
guidelines using the AGREE to prepare for the meeting. In the initial
meeting, the National Health and Medical Research Council (NHMRC)
guideline was used as supporting material as its section on recurrence
did not add much to that already published in the more extensive
guidelines. For the second meeting, panel members were asked to rate the
quality of the NHMRC guideline using the AGREE instrument -- mainly to
reacquaint them with the process and the material. Three members
completed the instrument (see Figure A1 and Table A1 in the original
guideline document).

Raw AGREE scores, summary AGREE graphs, guidelines and supporting
material, and the recommendations matrices were provided to the panel
members prior to the teleconference call.

The chair began the call with a review of the process and of the draft
statements completed at the end of the initial meeting. The panel
members then decided to work from this initial set of statements and the
recommendations matrix to derive the final list of recommendations. The
panel decided that for both platinum-sensitive and platinum-resistant
disease explanatory paragraphs needed to be attached to the
recommendations. These explanations represent the result of discussions
by the panel on various associated issues. Based on these two meetings,
a draft guideline was produced, edited and then circulated to all the
members of the panels for feedback and approval prior to gathering
feedback from a larger audience.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

External Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

**External Review**

Feedback on the draft recommendations was sought from 165 practitioners
who treat ovarian cancer from across Canada.

**Methods**

The draft guideline, a cover letter from the president of the Society of
Gynecologic Oncologists of Canada (GOC) and a survey were mailed to
practitioners. A reminder was sent approximately one month after the
mailing of the initial package. The survey asked for comments on the
guideline and also contained items evaluating the methods used in the
drafting of the guideline, whether the recommendations are applicable in
the practitioner\'s context, whether the recommendations should be
approved as a guideline, and whether the practitioner would use the
guideline in his or her practice.

**Feedback**

The overall response rate was 37% (see Table A3 in the original
guideline document). Responses were received from across Canada. The
main respondent group was gynecologic oncologists (62.5%), followed by
medical oncologists (25%), radiation oncologists and internal medicine
practitioners (3% each), and finally obstetricians/gynecologists and
psychosocial oncology (1% each).

Comments on the draft guideline were received from 29 of the
respondents. Half of these represented general comments, the other half
were suggestions for changes to the document. Of the suggestions, eight
were addressed in the addition of a section entitled \"Scope of the
guideline\" clarifying the purview of the guideline. Three reviewers
brought to the attention of the panel the recent publication of an
article where previously only the abstract was available. Other
suggestions resulted in the addition of supporting evidence to the
document, most references for Phase II trial of gemcitabine, etoposide
and vinorelbine, and a listing of currently active Phase 3 trials. An
addition was made to only one recommendation, 2.2, in which the long
treatment free interval was further clarified to be \"of at least one
year\".

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**1.0 General Statements**

1.1 Each patient is unique in her disease. Patients must be considered
as a whole when making treatment recommendations. The basic principle is
to use the most effective regimen or single agent. If the alternatives
are equally effective, then choose treatment based upon toxicity,
convenience, and availability.

1.2 Whenever clinical trials are available, all patients should be
offered participation in these trials.

1.2a Systemic therapy for recurrent ovarian cancer is not curative.

1.2b The goals of treatment should be to improve quality of life (or
symptom free interval or symptom intensity), or increase the progression
free interval.

1.3 Women can be subdivided into three groups predictive of response to
further platinum analogues: platinum-refractory (their cancer progresses
upon treatment) who will not respond to platins; platinum-resistant
(cancer recurs objectively within 6 months of completing
treatment)---they have a 10% response rate to further platins; and
platinum-sensitive (recurs more than 6 months after completing
treatment)---they have a 30% predicted response rates with platinum
retreatment. These latter two definitions are arbitrary and merely
reflect an artificial cutpoint chosen to best delineate higher and lower
response rates to subsequent treatment.

1.4 Repeated courses of chemotherapy can be effective in selected
patients. As a principle, re-utilize the previous effective drug(s)
until progression, (see section 1.1 above for principles) or undue
toxicity adversely impacting quality of life or treat for a defined
number of cycles.

**2.0 Platinum Sensitive Disease**

2.1 Whenever clinical trials are available, all patients should be
offered participation in these trials.

2.2 Patients who experience a long treatment free interval of at least
one year after exposure to platinum based chemotherapy should have the
opportunity for retreatment with either platinum based combination or
monotherapy. Platinum based combination therapy should be considered in
these patients.

2.3 Single agent platinum therapy is preferable for those patients who
have experienced significant toxicities (unless the platin was the
responsible agent).

2.4 If a platinum compound is not warranted due to toxicity, then choice
of systemic agent should be based on their toxicity profile, ease of
administration, and availability.

**3.0 Platinum Resistant Disease**

3.1 Whenever clinical trials are available, all patients should be
offered participation in these trials.

3.2 In a setting where clinical trials are not available or not
appropriate, there are many treatment options which have shown modest
response rate but their benefit over best supportive care has not been
studied in clinical trials.

3.3 Drugs with proven efficacy in this setting include etoposide
(Naumann et al., 1997; Rose et al., 1998; Kuhn et al., 1996),
gemcitabine (Shapiro et al., 1996; Kaufmann & von Minckwitz, 1997;
Coenen et al., 2000; von Minckwitz et al., 1999), liposomal doxorubicin
(Muggia et al., 1997; Medi-View Express Report, 1999; Gordon et al.,
2000), taxanes (Markman et al., 2000; Markman et al., 2002), topotecan
(Creemers et al., 1996; Bookman et al., 1998; Hochster et al., 1999;
Malmstrom, Sorbe, & Simonsen, 1996; Swisher et al., 1997; Markman et
al., 1999), or vinorelbine (Burger et al., 1999; Bajetta et al., 1996).

See Tables 1, 2, and 3 and list of chemotherapeutic agents in the
original guideline document, which have been assessed in randomized
controlled trials (RCTs) in patients who are platinum resistant. The end
points of effectiveness (response rate \[RR\], Survival, and toxicity
are outlined.

**4.0 Platinum Refractory Disease**

4.1 Whenever clinical trials are available, all patients should be
offered participation in these trials.

4.2 Patients who progress while upon a platin analogue should be
switched to another drug (or to symptom management alone) following
principles articulated in section 1.1 above.

**5.0 Stopping Chemotherapy**

As a patient is treated with repeated regimens of chemotherapy, there
may be diminishing benefits in terms of duration and degree of response.
There is a single institution Canadian study (Hoskins & Le, 2005) which
has shown that survival is less than 6 months when the length of
interval between the two preceding relapses is less than 12 months from
the 1 to 2nd relapse and less than 6 months from the 1st to 3rd, or 2nd
to 4th and so on. Thus, patients and their support network need to be
apprised of the situation and the purpose of further interventions. Best
supportive care based on the patient\'s current presentation (i.e., pain
then appropriate pain relief) should always be an option.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### REFERENCES SUPPORTING THE RECOMMENDATIONS

[References open in a new
window](http://www.guideline.gov/summary/select_ref.aspx?doc_id=10859)

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence is not specifically stated for each recommendation.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Appropriate use of systemic therapy in women with recurrent ovarian
cancer to improve care, quality of life, and survival

#### POTENTIAL HARMS

Drug toxicity

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

-   Care has been taken in the preparation of the information contained
    in this document. Nonetheless, any person seeking to apply or
    consult the practice guideline is expected to use independent
    medical judgments in the context of individual clinical
    circumstances or seek out the supervision of a qualified clinician.
    The Society of Gynecologic Oncologists of Canada makes no
    representation or warranties of any kind whatsoever regarding their
    content or use or application and disclaims any responsibility for
    their application or use in any way.

-   This guideline question raises a number of relevant topics which are
    either beyond the scope of this guideline, or for which no data
    exist. This guideline does not address such topics as the sequencing
    of chemotherapeutic agents, when to stop systemic therapy,
    definition of recurrent disease such as rising CA125 versus
    radiologic or clinical progression, the role of secondary surgical
    debulking, and the management of complications such as allergic
    reactions. Although these are important concerns in the care of
    patients with recurrent ovarian cancer, they need to be addressed in
    a different forum. Cost was not considered in this guideline as
    there are no cost effectiveness trials.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

This document represents a unique collaboration with national input and
practitioner feedback. This should lead to discussions at the provincial
level regarding care for these patients.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Living with Illness

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Elit L, Zitzelsberger L, Fung-Kee-Fung M, Brouwers M, Graham ID, Browman
G, Hoskins P, Lau S, Ghatage P, Society of Gynecologic Oncologists of
Canada (GOC). Use of systematic therapy in women with recurrent ovarian
cancer - development, methods and clinical practice guideline. Ottawa
(ON): Society of Gynecologic Oncologists of Canada (GOC); 2006 Oct.
Various p. \[21 references\]

#### ADAPTATION

The guideline was adapted from the following resources:

-   Fung Kee Fung M, Elit L, Hirte H, Rosen B, Chambers A, and members
    of the Gynecology Cancer Disease Site Group. Draft Guideline:
    Optimal chemotherapy treatment for women with recurrent ovarian
    cancer. Practice Guideline Report #4-3 version 2.2004.
    ([www.cancercare.on.ca](http://www.cancercare.on.ca/index_practiceGuidelines.htm))

-   Scottish Intercollegiate Guidelines Network.  SIGN #75: Epithelial
    ovarian cancer. A national clinical guideline. Scottish
    Intercollegiate Guidelines Network. 2003.
    ([www.sign.ac.uk](http://www.sign.ac.uk/))

-   BC Cancer Agency. Cancer Management Guidelines: Ovary -- Epithelial
    Carcinoma. ([www.bccancer.bc.ca](http://www.bccancer.bc.ca/))

-   The Australian Cancer Network and National Breast Cancer Centre.
    Clinical practice guidelines for the management of women with
    epithelial ovarian cancer. 2004 National Breast Cancer Centre,
    Camperdown, NSW.
    ([www.nhmrc.gov.au/publications](http://www.nhmrc.gov.au/publications))

-   National Institute of Health and Clinical Excellence, UK.
    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. Technology Appraisal 91. May 2005.
    ([www.nice.org.uk/TA091](http://www.nice.org.uk/TA091))

-   National Cancer Institute, U.S. National Institutes of Health.
    Ovarian Epithelial Cancer (PDQ) Treatment. June 16, 2005.
    ([www.nci.nih.gov](http://www.nci.nih.gov/))

-   National Comprehensive Cancer Network. Ovarian Cancer. Version
    1.2005. 2004. ([www.nccn.org](http://www.nccn.org/))

-   MD Anderson. Epithelial Ovarian Cancer. 1999.
    ([www.mdanderson.org](http://www.mdanderson.org/))

#### DATE RELEASED

2006 Oct

#### GUIDELINE DEVELOPER(S)

Society of Gynecologic Oncologists of Canada - Disease Specific Society

#### SOURCE(S) OF FUNDING

Society of Gynecologic Oncologists of Canada

#### GUIDELINE COMMITTEE

Not stated

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

**Initial Panel -- March 2005**

*Clinical Specialists*: Laurie Elit, *Chair*, Gynecologic Oncologist,
Juravinski Cancer Centre; Peter Craighead, Radiation Oncologist, Tom
Baker Cancer Centre, Alberta; Lesa Dawson, Gynecologic Oncologist,
Newfoundland Cancer Treatment and Research Foundation; Michael
Fung-Kee-Fung, Gynecologic Oncologist, Ottawa Hospital Regional Cancer
Centre; Walter Gotlieb, Gynecologic Oncologist, Jewish General Hospital,
Québec; Prafull Ghatage, Gynecologic Oncologist, Tom Baker Cancer
Centre, Alberta; Robert Lotocki, Gynecologic Oncologist, Cancer Care
Manitoba; Dianne Miller, Gynecologic Oncologist, BC Cancer Agency; Joan
Murphy, Gynecologic Oncologist, University Health Network, Ontario;
Diane Provencher, Gynecologic Oncologist, Hôpital Notre-Dame, Québec,
President of GOC; Barry Rosen, Gynecologic Oncologist, University Health
Network, Ontario; Réjean Savoie, Gynecologic Oncologist, New Brunswick;
Luis Souhami, Radiation Oncologist, Montréal General Hospital, Québec;
Gavin Stuart, Gynecologic Oncologist, Dean of Medicine, University of
British Columbia; Ken Swenerton, Medical Oncologist, BC Cancer Agency

*Methodologists Supporting the Workshop*: Melissa Brouwers, Program in
Evidence based Care, Cancer Care Ontario; George Browman, Haematologist,
CEO Tom Baker Cancer Centre; Ian D. Graham, Health Sociologist, Ottawa
Health Research Institute; Louise Zitzelsberger, Research Methodologist,
Ottawa Health Research Institute

*Observers - Members of the CSCC CPG-AG*: Louise Paquet, Québec
Guidelines Group, Government of Québec; Jill Petrella, Cancer Care Nova
Scotia

**Sub-panel Membership - December 2005**

*Clinical Specialists*: Laurie Elit, *Chair*, Gynecologic Oncologist,
Juravinski Cancer Centre; Michael Fung-Kee-Fung, Gynecologic Oncologist,
Ottawa Hospital Regional Cancer Centre; Prafull Ghatage, Gynecologic
Oncologist, Tom Baker Cancer Centre, Alberta; Susie Lau, Gynecologic
Oncologist, Jewish General Hospital, Montréal, Quebec; Barry Rosen,
Gynecologic Oncologist, University Health Network, Ontario; Ken
Swenerton, Medical Oncologist, BC Cancer Agency

*Methodologist*: Louise Zitzelsberger, Research Methodologist, Ottawa
Health Research Institute

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Panel members were asked to complete and sign a conflict of interest
declaration which asked them to report their involvement on guideline
development groups, as an employee of a guideline development group, or
as a consultant for a guideline developer or entity with a commercial
interest in any of the guidelines under consideration; whether they had
any ownership interests in  entities with a commercial interest in the
guidelines under consideration, had received research  funding or
honoraria from entities with a commercial interest in the guidelines
under consideration, or were involved in officially endorsing a
guideline. Five panel members had been involved in the authorship of
guidelines selected for quality appraisal: two were involved in the
British Columbia (BC) Cancer Agency Management Protocol, and three were
involved in writing the draft revised Cancer Care Ontario (CCO) #4-3
guideline.  Three other panel members had been involved in guideline
development, but for guidelines unrelated to the current topic. One
panel member had sat on an advisory board with respect to two drugs,
liposomal doxorubicin and topotecan, which can be used in the treatment
of recurrent ovarian cancer.

#### GUIDELINE STATUS

This is the current release of the guideline.

#### GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) from the
[Society of Gynecologic Oncologists of
Canada](http://g-o-c.org/uploads/final cpg - use of systemic therapy in women with recurrent ovarian cancer.pdf).

Print copies: Available from the Society of Gynecologic Oncologists of
Canada, 780 Promenade Echo Drive, Ottawa, ON K1S 5R7, Canada; Phone:
1.800.561.2416 Ext. 250

#### AVAILABILITY OF COMPANION DOCUMENTS

None available

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI Institute on July 26, 2007. The
information was verified by the guideline developer on July 26, 2007.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which may be
subject to the guideline developer\'s copyright restrictions.

### DISCLAIMER

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Date Modified: 11/3/2008