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PHRM 864 > Exam 2: Ovarian Cancer > Flashcards

Exam 2: Ovarian Cancer Flashcards

1
Q
A
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2
Q

incessant ovulation

A
  • women’s risk of developing ovarian cancer is related to her number of ovulatory cycles
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3
Q

Risk Factors

A
  • early menarche
  • late menopause
  • increased age
  • nulliparity
  • in vitro
  • two or more first degree relatives with ovarian cancer
  • BRCA-1, BRCA-2, p53
  • lynch syndrome
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4
Q

Decreased risk

A
  • multiple pregnancies
  • prolonged use of oral contraceptives
  • prophylactic oophorectomy
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5
Q

Why is ovarian cancer called the silent killer?

A
  • most patients with Stage I and II are asymptomatic
  • people present with advance disease (III and IV)
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6
Q

Clinical Presentation

A
  • lack of definitive symptoms
  • if a woman experiences symptoms for 12 or more days out of a month for 2 consecutive months, she should seek medical attention by her gynecologist
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7
Q

What is the most common presenting symptom

A

ascities

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8
Q

Initial treatment approach

A
  • goal is cure (up to stage III)
  • surgery + chemo is standard approach first line
  • with relapse, any therapy is palliative
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9
Q

Homologous Recombination

A

50% high grade serious ovarian carcinomas are HRD

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10
Q

Surgery

A
  • dubulking
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11
Q

Optimally debulked

A

< 1 cm of disease

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12
Q

sub-optimally debulked

A

> 1 cm of disease
poorer prognosis

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13
Q

Stage IA or 1B grade 1 disease treatment

A
  • observation and follow up every 3 months
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14
Q

Stage II and up treatment

A

adjuvant paclitaxel carboplatin

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15
Q

Calvert equation

A

carboplatin dose = AUC x (GFR +25)

AUC is usually 5-7.5

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16
Q

Type I Hypersensitivity

A
  • Initial contact with agent
  • cross linking to mast cells and basophils which trigger release of histamine and other inflammatory mediators
  • anaphylaxis, itching, rash, chest tightness
17
Q

Type IV Hypersensitivity

A
  • with repeated exposure to agent
  • MHC and APC, T-cells recognize antigens
  • erythema, induration
18
Q

Drugs that cause allergic reactions

A
  • carboplatin
  • cisplatin
  • docetaxel
  • paclitaxel
  • need desensitization
19
Q

Infusion related reactions

A
  • paclitaxel - cremophor EL
  • doxil - liposome
  • decrease rate
20
Q

Drug allergic reaction symptoms

A
  • hives, rash
  • projectile vomiting
  • swelling
  • SOB
  • symptoms persist after stopping infusion
21
Q

Infusion related reactions signs and symptoms

A
  • flushing
  • redness
  • tingling
  • headach
  • SOB
  • pain (abdominal and chest)
  • symptoms resolve after stopping infusion
22
Q

Paclitaxel

A
  • most manifest as type I reaction
  • happens with first dose, non-IgE mediated
  • due to cremophor el diluent as opposed to the chemo itself
23
Q

taxane infusion reactions

A
  • occurs during first or second exposure
  • risk of having recurrent rxn decreases with repeated exposure
24
Q

Paclitaxel standard premedications

A
  • dex
  • diphenhydramine
  • pepcid
25
Q

carboplatin hypersensitivity

A

mechanism can be type I or type IV

  • ≥ 8 cycles of carboplatin can increase risk of hypersensitivity
26
Q

Maintenance Bevacizumab

A
  • recommended in those that received bevacizumab with chemo upfront prior to surgery to continue monotherapy
  • not recommended in those with BRCA mutations
27
Q

Parp inhibitors

A

prevent parp protein from repairing damaged DNA in cancer cells

28
Q

Parp inhibitors approved in oviarian cancer

A
  • olaparib
  • rucaparib
  • niraparib
29
Q

Monitoring parameters PARP inhibitors

A

CBC, anemia

30
Q

Prevention of Adverse Effects

A
  • patient education
  • medication review for drug/drug interactions
  • antiemetics
  • nutrition
  • multivitamin with iron
31
Q

Monitoring parp

A
  • cbc
  • albumin
  • SCr
  • liver enzymes
  • cholesterol
32
Q

rare adverse events parp

A
  • MDS or AML
  • pneumonitis
33
Q

Metastatic disease

A
  • ultimately, 60-80% of patients will relapse
  • the goal is no longer cure
34
Q

If the patient relapses > 6 months following completion of their initial counting regimen

A
  • platinum sensitivie
  • may be treated with initial chemo regimen again
    = paclitaxel/carboplatin
35
Q

If the patient relapses < 6 months following completion of their initial counting regimen

A

platinum resistant

36
Q

Platinum progressive

A
  • no response or progression of disease during primary therapy with paclitaxel/carboplatin
37
Q

chemo options if platinum resistant

A

liposomal doxorubicin (single agent)

38
Q

combination chemo

A

platinum combo with paclitaxel

39
Q

ovarian screening

A

no effective screening tool

PHRM 864 (11 decks)

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