Chemotherapy trials

Question 1

Which type of mucinous ovarian cancer needs nodal sampling and adjuvant chemotherapy at Stage IA (expansile vs. infiltrative)?

Answer 1

Infiltrative

Question 2

GOG 157

Answer 2

3 vs. 6 cycles of carboplatin 7.5 AUC and paclitaxel 175 mg/m2 for Stage 1A/B grade 3, Stage 1C, Stage II, or clear cell ovarian cancer
- Non-significant trend toward lower risk of recurrence in hgsoc (24%)
- No difference in 5-year overall survival
- followed action and icon-7 that found OS benefit with 6 vs 0 cycles

Question 3

GOG 241

Answer 3

Capecitabine/oxaliplatin vs. paclitaxel/carboplatin +/- bevacizumab in Stage II-IV or recurrent Stage I mucinous ovarian cancer
- Failed accrual
- Higher response rate with carbo-paclitaxel-bev (57 vs. 29%)

Question 4

What is a particular side effect of oxaliplatin?

Answer 4

Acute neuropathy with paresthesia, sensory loss, loss of reflexes (85-95%)

Question 5

What is platinum-resistant rate in primary ovarian cancer?

Answer 5

15%

Question 6

GOG 111

Answer 6

Cisplatin + cyclophosphamide vs. Cisplatin + paclitaxel -> 14 month longer OS, 30% reduction of death

Question 7

GOG 158

Answer 7

Carboplatin-paclitaxel equal to Cisplatin-paclitaxel in PFS and OS (?9 month greater OS) with improved toxicity (emesis, leukopenia, nephropathy) and QOL

Question 8

GOG 182/ICON-5

Answer 8

No survival advantage to triplet or sequential doublet therapy
- Carboplatin-paclitaxel
- Carboplatin-paclitaxel-gemcitabine
- Carboplatin-paclitaxel-doxorubicin
- Carboplatin-topotecan + paclitaxel later
- Carboplatin-gemcitabine + paclitaxel later

Question 9

Docetaxel vs. Paclitaxel

Answer 9

Equivalent PFS and OS in Scottish RCT, less neurotoxicity and greater myelotoxicity, +edema (needs steroids)

Question 10

GOG 178

Answer 10

3 vs. 12 months maintenance paclitaxel 175 mg/m2  7 month improved PFS, no difference in OS

Question 11

Bevacizumab in recurrent platinum-sensitive ovarian cancer

Answer 11

GOG 213: 5-month increase in OS
OCEANS: 4-month increase in PFS

Question 12

Bevacizumab in platinum-resistant ovarian cancer

Answer 12

Aurelia: 3-month PFS benefit
Bevacizumab 10 mg/kg q2 or 15 q3wk + weekly paclitaxel 80 mg/m2 OR topotecan 4 mg/m2 D1/18/15 q4wk OR Doxorubicin 40 mg/m2 q4w

Question 13

Bevacizumab in primary ovarian cancer

Answer 13

GOG 218: 3 month PFS benefit, No difference in OS
ICON-7: 2 month PFS benefit, 5 month benefit in FIGO III-IV with > 1 cm residual disease

Question 14

Platinum-resistant PARP inhibitor trials in ovarian cancer

Answer 14

Study 1, ARIEL-2, QUADRA

Question 15

Platinum-sensitive maintenance PARP inhibitor trials in recurrent ovarian cancer

Answer 15

SOLO-2, ARIEL-3, NOVA

Question 16

Frontline PARP inhibitor maintenance trials in ovarian cancer

Answer 16

SOLO-1, PRIMA, PAOLA-1, VELIA (PARP with chemo)

Question 17

GOG 172

Answer 17

OS benefit with IP cisplatin

Question 18

GOG 252

Answer 18

No clear benefit of IP with bev, dose-dense, and IP as comparators

Question 19

PAOLA-1 population

Answer 19

All comers, but no benefit in HRD negative

Question 20

Frontline bevacizumab maintenance trials in ovarian cancer

Answer 20

ICON-7 (12 cycles)
GOG 218 (22 cycles)

Question 21

Carboplatin dosing (Calvert formula)

Answer 21

Total dose = target AUC * (GFR + 25)

Question 22

AUC

Answer 22

Concentration * time
Aka plasma clearance of a drug

Question 23

Creatinine clearance (Cockcroft-Gault formula)

Answer 23

((140-age)body weight (kg) * 0.85)/72creatinine