exam 2 lecture 6 (ovarian cancer)

Question 1

What is the leading cause of death in the US from gynecologic malignancies (ovarian, cervicak, endometrial)

Answer 1

Ovarian

Question 2

how does ovarian cancer happen?

Answer 2

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

Question 3

risk factors of ovarian cancer

Answer 3

Early menarche, late menopause
increased age
invitro fertilization
FH

Question 4

how to decrease risk for ovarian cancer

Answer 4

Multiple kids
oral contraceptives
oophorectomy

Question 5

symptoms of ovarian cancer

Answer 5

Stage I and II are asymptomatic. Usually caught at stage III.

Question 6

How is ovarian cancer usually treated? Does it respond well? WHat is the caveat?

Answer 6

surgery and ovarian cancer. it is a chemo sensitive drug. It responds well but the caveat is that most women recur within 3 years

Question 7

how do we decide treatent on ovarian cancer

Answer 7

Genetic risk evaluation done to see if BRCA mutations are present. IN absence of BRCA mutations, homologous recombination deficiency (HRD) determines therapy

Question 8

treatment overview of ovarian cancer

Answer 8

surgery
adjuvant chemo
relapse
recurrence therapy (chemo again)
maintenance of recurence

Question 9

after surgery, patients are divided into two groups. What are these groups?

Answer 9

optimally debulked- <1 cm of disease
sub-optimally debukled- >1 cm of disease (poorer prognosis)

Question 10

treatment of stage IA or IB grade I disease

Answer 10

observation and follow up

Question 11

How to treat ovarian cancer that is not stage IA or I B? Treatment of choice for all non stage IA or IB diseases

Answer 11

Cytoreductive surgery followed by adjuvant chemotherapy

Standard of choice- paclitaxel, carboplatin, every 21 days 6 cycles

Question 12

How is carboplatin dosed?

Answer 12

calvert equation

AUC X (GFR+25)

Question 13

how to calculate GFR (CRCL) for carboplatin dosing

Answer 13

(140-age) x weight
—————————- (x0.85 in females)
72* Scr

Question 14

compare type I vs type 4 hypersensitivity rxn

Answer 14

type I- the minute it is exposed we have reaction. (anaphylaxis, itching)

Type 4 is delayed, repeated exposure over time.

Question 15

Which drugs are usually type 4? Which drugs are usually infusion related?

Answer 15

1. allergic to drug itself (type 4)- carboplatin, cisplatin, docetaxel, paclitaxel. NEED SENSITIZATION symptoms persist after stopping infusion
2. infusion related (type 1)- paclitaxel- (to the cremophor EL)
   Doxil (to the liposome)

decreasing infusion rate typically solves symptoms

Question 16

How to avoid type 1 rxn to paclitaxel

Answer 16

premedicate with dexamethasone, diphenhydramine, famotidine

Prolonging infusion may resolve sx

Question 17

how to avoid type I docetaxel hs rxn

Answer 17

dexamethasone

Question 18

What type of HS do we see with carboplatin? what is it caused by

Answer 18

Type 4 (allergic)
Repeated exposure (>8 cycles)

Question 19

can we give patient paclitaxel if they had a HS rxn? How about carboplatin

Answer 19

yes to both

Question 20

after surgery and paclitaxel/carboplatin, what do we do for ovarian cancer patient? side effects

Answer 20

bevacizumab as maintenance

high BP, proteinuria,

Question 21

PARP inhibitor drugs

Answer 21

olaparib
Niraparib
RUcaparib

Question 22

What two PARP drugs are approved after carboplatin/paclitaxel tx

Answer 22

Olaparib
Niraparib

Question 23

difference between niraparib and olaparib

Answer 23

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

Question 24

WHat to check when on olaparib, niraparib and rucaparib? side effect?

Answer 24

CBC check
DRUG-DRUG INTERACTIONS

side effects- anemia

Question 25

What regimens to do when ovarian cancer recurs

Answer 25

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)

Question 26

screening and prevention of ovarian cancer

Answer 26

no effective screening tool
high risk woman (hereditary/brca)- pelvic exam, transvaginal ultrasound every 6-12 months

counsel on use of oral contraceptive