NCCN Flash Update: Ovarian Cancer Guidelines Version 3.2025 Released With Maintenance Therapy Adjustment for HR-Deficiency

The National Comprehensive Cancer Network (NCCN) has released Version 3.2025 of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for ovarian cancer, along with corresponding updates to the NCCN Drugs & Biologics Compendium. These updates include a modification to maintenance therapy recommendations that oncology pharmacists should be aware of when optimizing treatment plans for patients with epithelial ovarian, fallopian tube, or primary peritoneal cancers.

Key Change to Maintenance Therapy

The NCCN Guidelines for ovarian cancer has updated maintenance therapy options in section OV-5 of the guidelines. For patients with BRCA1/2 wild-type or unknown status who did not receive bevacizumab (Avastin; Genentech) during primary therapy and are identified as homologous recombination (HR) deficient, the recommended maintenance therapy has been modified to include niraparib (Zejula; GlaxoSmithKline) monotherapy.

This adjustment underscores the growing emphasis on tailoring maintenance therapy based on molecular characteristics beyond BRCA mutation status alone. Pharmacists should carefully review patients’ HR deficiency (HRD) testing results to guide treatment selection and ensure appropriate monitoring for PARP inhibitor-associated toxicities, including hematologic adverse effects.

Implications for Oncology Pharmacists

Oncology pharmacists are essential in ensuring the successful implementation of updated treatment strategies, such as the use of niraparib in HR-deficient ovarian cancer. Their expertise in interpreting genetic and HRD testing results, educating patients and providers, managing oral maintenance therapies, and collaborating with multidisciplinary teams enables personalized, evidence-based care that aligns with evolving clinical guidelines.

REFERENCE

NCCN. Clinical Practice Guidelines in Oncology. Ovarian cancer, version 3.2025. July 16, 2025. Accessed July 18, 2025. https://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf