Chemotherapy

Question 1

Two classification systems used to define fitness for treatment prior to chemotherapy.

Answer 1

RCOG performance status
0 -4. 
0 = independent, 
1 = active >50% + light tasks, 
2 = active >50%, no light tasks, 
3 = active <50% day + assist some ADLs,  4 = active <50% day, needs helps with ADLS

WHO
0 = fully active and able
1= restricted strenuous activity
2= selfcare
3= limited self care
4= completely disabled
5 = dead

Question 2

How is chemotherapy dosed?

Answer 2

By BSA (mg/2)
carboplatin by renal function (Calvert formula)

(GFR +25)x AUC = dose

Question 3

How to assess clinical response to chemotherapy?

Answer 3

clinical examination
measurement tumor markers
radiological imaging

Question 4

define disease progression with chemotherapy

Answer 4

> 20% increase in sum of target lesions

Question 5

define stable disease

Answer 5

<20% increase but <30% decrease in sum of lesions. no new lesions

Question 6

partial response to chemotherapy defined by?

Answer 6

> 30% decrease in sum of target lesions, nil new.

Question 7

Chemo-agents used for epithelial ovarian cancer?

Answer 7

carboplatin and paclitaxel

Question 8

Side effects paclitaxel

Answer 8

pate = alopecia
puke = N+V
pins = peripheral neuropathy
pee = AKI

Question 9

Carboplatin side effects?

Answer 9

suppression bone marrow (plt, neut)

kidneys (AKI)

Question 10

What trial demonstrated benefit of chemotherapy in stage 1 EOC with high grade features?

Answer 10

ICON 1 trial

Question 11

Response rate of EOC to chemotherapy?

Answer 11

70% exhibit response to adjuvant.

Question 12

When would neoadjuvant chemo be used for EOC?

Answer 12

Stage IIC or IV. Reduces surgical morbidity compared to primary debulking (EORTC)

Question 13

Compare paclitaxel to cisplatin in treatment of EOC.

Answer 13

similar effect. Less nephrology and neurotoxic. Less vomiting. (ICON 2)

Question 14

Response rate of EOC to palliative chemotherapy?

Answer 14

25-60%.

Etoposide PO used for platinum resistant disease.

Question 15

What non-epithelial ovarian malignancies are treated with chemotherapy?

Answer 15

sex cord and germ cell tumors. primary surgery considered first for fertility preservation.

Question 16

What chemotherapy regimens are recommended for granuloma cell tumors?

Answer 16

BEP

= bleomycin, etoposide cisplatin

Question 17

Chemotherapy regime for germ cell tumors?

Answer 17

BEP ( bleomycin, etoposide, cisplatin)
OR
PVB (cisplatin, vinblastine, bleomycin)

Question 18

When should chemo radiation be considered for cervical cancer?

Answer 18

Stage I-IV cancer

Results in 30-50% reduction in RR of relapse or death

Question 19

What type of chemotherapy is given for cervical cancer?

Answer 19

Cisplatin

Question 20

What does adjuvant chemotherapy for endometrial cancer involve?

Answer 20

progestogen therapy
platinum and paclitaxel based regimes.

no trials have demonstrated improved survival.

Question 21

When would adjuvant chemo radiation be considered for vulval Ca?

Answer 21

• incomplete/inadequate excision margin
• inguinal or pelvic lymph node involvement

Chemo used with radiotherapy. Can be used as neoadjuvant to reduce need for radical surgery.

Question 22

What are the chemo regimes used for GTN?

Answer 22

low risk (WHO <7) = MTX/folinic acid

high risk = etoposide (E), Methotrexate (M), actinomycin (A), cyclophosphamide (C), Vincristine (O)
EMA-CO