Exam 2: Ovarian Cancer Flashcards
incessant ovulation
- women’s risk of developing ovarian cancer is related to her number of ovulatory cycles
Risk Factors
- 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
Decreased risk
- multiple pregnancies
- prolonged use of oral contraceptives
- prophylactic oophorectomy
Why is ovarian cancer called the silent killer?
- most patients with Stage I and II are asymptomatic
- people present with advance disease (III and IV)
Clinical Presentation
- 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
What is the most common presenting symptom
ascities
Initial treatment approach
- goal is cure (up to stage III)
- surgery + chemo is standard approach first line
- with relapse, any therapy is palliative
Homologous Recombination
50% high grade serious ovarian carcinomas are HRD
Surgery
- dubulking
Optimally debulked
< 1 cm of disease
sub-optimally debulked
> 1 cm of disease
poorer prognosis
Stage IA or 1B grade 1 disease treatment
- observation and follow up every 3 months
Stage II and up treatment
adjuvant paclitaxel carboplatin
Calvert equation
carboplatin dose = AUC x (GFR +25)
AUC is usually 5-7.5
Type I Hypersensitivity
- 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
Type IV Hypersensitivity
- with repeated exposure to agent
- MHC and APC, T-cells recognize antigens
- erythema, induration
Drugs that cause allergic reactions
- carboplatin
- cisplatin
- docetaxel
- paclitaxel
- need desensitization
Infusion related reactions
- paclitaxel - cremophor EL
- doxil - liposome
- decrease rate
Drug allergic reaction symptoms
- hives, rash
- projectile vomiting
- swelling
- SOB
- symptoms persist after stopping infusion
Infusion related reactions signs and symptoms
- flushing
- redness
- tingling
- headach
- SOB
- pain (abdominal and chest)
- symptoms resolve after stopping infusion
Paclitaxel
- most manifest as type I reaction
- happens with first dose, non-IgE mediated
- due to cremophor el diluent as opposed to the chemo itself
taxane infusion reactions
- occurs during first or second exposure
- risk of having recurrent rxn decreases with repeated exposure
Paclitaxel standard premedications
- dex
- diphenhydramine
- pepcid
carboplatin hypersensitivity
mechanism can be type I or type IV
- ≥ 8 cycles of carboplatin can increase risk of hypersensitivity
Maintenance Bevacizumab
- recommended in those that received bevacizumab with chemo upfront prior to surgery to continue monotherapy
- not recommended in those with BRCA mutations
Parp inhibitors
prevent parp protein from repairing damaged DNA in cancer cells
Parp inhibitors approved in oviarian cancer
- olaparib
- rucaparib
- niraparib
Monitoring parameters PARP inhibitors
CBC, anemia
Prevention of Adverse Effects
- patient education
- medication review for drug/drug interactions
- antiemetics
- nutrition
- multivitamin with iron
Monitoring parp
- cbc
- albumin
- SCr
- liver enzymes
- cholesterol
rare adverse events parp
- MDS or AML
- pneumonitis
Metastatic disease
- ultimately, 60-80% of patients will relapse
- the goal is no longer cure
If the patient relapses > 6 months following completion of their initial counting regimen
- platinum sensitivie
- may be treated with initial chemo regimen again
= paclitaxel/carboplatin
If the patient relapses < 6 months following completion of their initial counting regimen
platinum resistant
Platinum progressive
- no response or progression of disease during primary therapy with paclitaxel/carboplatin
chemo options if platinum resistant
liposomal doxorubicin (single agent)
combination chemo
platinum combo with paclitaxel
ovarian screening
no effective screening tool
