exam 2 lecture 6 (ovarian cancer) Flashcards
What is the leading cause of death in the US from gynecologic malignancies (ovarian, cervicak, endometrial)
Ovarian
how does ovarian cancer happen?
Incessant ovulation theory- ovulation results in disruption and repair of epithelial lining. The repair of the lining is proposed as one of sporadic ovarian cancer
BRCA 1 or 2 mutations
risk factors of ovarian cancer
Early menarche, late menopause
increased age
invitro fertilization
FH
how to decrease risk for ovarian cancer
Multiple kids
oral contraceptives
oophorectomy
symptoms of ovarian cancer
Stage I and II are asymptomatic. Usually caught at stage III.
How is ovarian cancer usually treated? Does it respond well? WHat is the caveat?
surgery and ovarian cancer. it is a chemo sensitive drug. It responds well but the caveat is that most women recur within 3 years
how do we decide treatent on ovarian cancer
Genetic risk evaluation done to see if BRCA mutations are present. IN absence of BRCA mutations, homologous recombination deficiency (HRD) determines therapy
treatment overview of ovarian cancer
surgery
adjuvant chemo
relapse
recurrence therapy (chemo again)
maintenance of recurence
after surgery, patients are divided into two groups. What are these groups?
optimally debulked- <1 cm of disease
sub-optimally debukled- >1 cm of disease (poorer prognosis)
treatment of stage IA or IB grade I disease
observation and follow up
How to treat ovarian cancer that is not stage IA or I B? Treatment of choice for all non stage IA or IB diseases
Cytoreductive surgery followed by adjuvant chemotherapy
Standard of choice- paclitaxel, carboplatin, every 21 days 6 cycles
How is carboplatin dosed?
calvert equation
AUC X (GFR+25)
how to calculate GFR (CRCL) for carboplatin dosing
(140-age) x weight
—————————- (x0.85 in females)
72* Scr
compare type I vs type 4 hypersensitivity rxn
type I- the minute it is exposed we have reaction. (anaphylaxis, itching)
Type 4 is delayed, repeated exposure over time.
Which drugs are usually type 4? Which drugs are usually infusion related?
- allergic to drug itself (type 4)- carboplatin, cisplatin, docetaxel, paclitaxel. NEED SENSITIZATION symptoms persist after stopping infusion
- infusion related (type 1)- paclitaxel- (to the cremophor EL)
Doxil (to the liposome)
decreasing infusion rate typically solves symptoms
How to avoid type 1 rxn to paclitaxel
premedicate with dexamethasone, diphenhydramine, famotidine
Prolonging infusion may resolve sx
how to avoid type I docetaxel hs rxn
dexamethasone
What type of HS do we see with carboplatin? what is it caused by
Type 4 (allergic)
Repeated exposure (>8 cycles)
can we give patient paclitaxel if they had a HS rxn? How about carboplatin
yes to both
after surgery and paclitaxel/carboplatin, what do we do for ovarian cancer patient? side effects
bevacizumab as maintenance
high BP, proteinuria,
PARP inhibitor drugs
olaparib
Niraparib
RUcaparib
What two PARP drugs are approved after carboplatin/paclitaxel tx
Olaparib
Niraparib
difference between niraparib and olaparib
olaparib needs BRCA mutation to be used after first line treatment with carboplatin/paclitaxel. (BRCA mutation not required to be used after relapse)
Niraparib did not need BRCA mutation to be used as maintenance after first line therapy
WHat to check when on olaparib, niraparib and rucaparib? side effect?
CBC check
DRUG-DRUG INTERACTIONS
side effects- anemia
What regimens to do when ovarian cancer recurs
If pt relapses>6 months, the patient is platinum sensitive. May be treated with same treatment (paclitaxel, carboplatin). increased risk for HS rxn
If pt relapses < 6 months, they are platinum resistant and we would switch chemo treatment (liposomal doxorubicin to be used)
(platinum progressive means no response to chemo)
screening and prevention of ovarian cancer
no effective screening tool
high risk woman (hereditary/brca)- pelvic exam, transvaginal ultrasound every 6-12 months
counsel on use of oral contraceptive
