Mucinous ovarian cancer Flashcards
Compare the epidemiology of mucinous ovarian cancer vs. HGS ovarian cancer in regards to:
- Age
- Stage
- Tumor markers
- Risk factors
- Response to platinum-based chemo
- Overall survival at early vs advanced stage
- What are clinico-pathologic features of mucinous ovarian cancer?
- What are the staining patterns?
- Molecular profile?
- What are clinico-pathologic features of mucinous ovarian cancer?
- see slide
- What are the staining patterns?
- see slide
- CK7 neg is for colorectal cancers
- Molecular profile?
- Mutations in decreasing order of frequency; KRAS, BRAF, PTEN, and HER-2 neu
- Very heterogenous landscape and poorly understood
What is the natural progression of mucinous ovarian cancer?
What mutation is an early event?
- What are the diagnostic criteria and workup for mucinous ovarian cancer?
- Why is central review by gyn pathologist so important?
- What are differences in management for the types of mucinous ovarian cancer and why?
- What are the diagnostic criteria and workup for mucinous ovarian cancer?
- see slide
- Why is central review by gyn pathologist so important?
- NEED confirmation by expert pathologist
GOG 182: retrospective analysis 54 of 3000 were mucinous but 44 had independent review and only 40% were PRIMARY ovarian and rest were mets from GI origin
- NEED confirmation by expert pathologist
- What are differences in management for the types of mucinous ovarian cancer and why?
- Majority of expansile subtype = stage I
- Good proportion of infiltrative subtype had LN mets
NCCN guidelines for treatment of mucinous ovarian cancer?
How do you surgically manage apparent early stage mucinous cancer?
What are ESMO guidelines for early stage mucinous ovarian cancer?
The guidelines take into account the mucinous subtypes
Would you consider giving carbo-taxol in patients with early stage mucinous ovarian cancer? If so, how many cycles and why?
Can give carbo/taxol x 3 cycles based on GOG 157
GOG 157
- Design
- RCT
- Surgically staged EOC with G3 stage IA-B, clear cell, stage IC, or completely resected stage II disease
- R0
- Carbo/taxol x3 vs x6 cycles
- Results
- No difference in PFS, OS
- More toxicity
What adjuvant chemotherapy regimens can be given to early-stage mucinous OC?
What was GOG 241 and what were the findings?
Design
- RCT of stage II-IV mucinous ovarian cancer
- Carbo/taxol +/- bev VS oxaliplatin/capecitabine +/- bev
Results
- Trial closed after 5 years due to poor accrual
- Preliminary results showed no difference but underpowered
- Also, no central review was required for enrolment but half of patients were reclassified as metastatic mucinous from GI source instead of primary mucinous ovarian!
What evidence do we have that a GI regimen for chemotherapy may be good for mucinous ovarian cancers?
- Retrospective review by MDACC/Johns Hopkins
- GI vs GYN regimen
- Patient characteristics similar but more GYN patients had bev also added to chemo
- OS and PFS better in the GI regimen group
Chemotherapy options for advanced mucinous ovarian cancer?
GI protocol dosing for FOLFOX and XELOX regimens?
XELOX (aka CAPOX) protocol used more often.
What are oxaliplatin-induced toxicites?
- Dose-limiting toxicity? Detail the characteristics of this toxicity.
Dose-limiting usually is neuropathy
- Can be acute (within hours or days) - resolves within 7-days and usually worsened by cold in periphery.
- See table
- Avoid cold exposure esp cold drinks
See slide for other toxicities
How do you dose reduce oxaliplatin?
Use of HIPEC in mucinous ovarian cancer?
Controversial
What do we do for recurrent disease?
- Limited options
- Molecular profiling
- Possibly clinical trials (though usually not included histo type)
Take home points for mucinous ovarian cancer
