ovarian Flashcards
interval debulking ovarian
not data driven
optimal debulking ovarian
30% cure, PFS 23 mo, OS 52mo (with IP therapy, 66mo, with complete debunking 90mo)
cis v. carbo for ovarian
no advantage of cis.
IP chemo for ovarian
survival benefit stage III
weekly taxol + q3wk carbo
improved survival compared to q3wk
GOG0218- bevacizumab in early stage
no OS benefit, modest PFS benefit
stage III ovarian optimally debulked
IP chemo! (IV an option if cannot)
stage III - IV regimen
ddP (weekly) plus carbo has improved OS over q3wk. adding bev nullifies need for weekly. in US we don’t do the bev
olaparib for ovarian
4rd line for later, BRCA mutant. risk of MDS/secondary malignancies, median 7-9 month PFS
platinum sensitive v. resistant
6 months
what do you do with rising CA125 with ovarian
you can use aromatase inhibitor or tamoxifen. early v. later doesn’t confer advantage
secondary debulking? any benefit of debulking at relapse
MSKCC- if >12 month RFI, and complete excision possible, then consider. but not based on randomized data
platinum sensitive recurrence
taxol to carbo, gem, or doxil
platinum hypersensitivity
12% of pts, median 8 cycles, occur in latter 3rd of infusion, potentially life-threatening, you can prophlax, refer to allergist
OCEANS study- bev for recurrence
PFS advantage of 4 months , no OS but high crossover,
cediranib + chemo in platinum sensitive
modest PFS benefit, 3 month survival advantage
response rates for recurrent ovarian
30% for sensitive, 10% ORR for resistant: etoposide, topotecan, gem, pemetrexid, doxil, vino, irino
does it matter what chemo to give in ovarian recurrent
no
CA125 response with chemo
you need to wait 3-4 cycles for response
AURELIA study- bev for platinum resistance
chemo + bev in platinum resistant has doubling of response rate with taxol, gem, doxil, doubling of PFS. no survival advantage
maintenance therapy with early stage ovarian debulked?
no? PFS advantage but no OS advantage with taxol. study ongoing for olaparib
STIC
precursor to serous ovarian- p53+
clear cell ovarian/endometriod ovarian
HNPCC. Clear cell has pI3k
low grade serous ovarians
BRAF, KRAS, NRAS. maybe MEKi works.
stage 1a grade 1/2 serous chemo treatment
observe only
early stage ovarian (stage I) high risk
+washings, surgical spill/rupture, but no spread beyond ovaries. no advantage of 6 cycles versus 3 of adjuvant chemo. (GOG157),
clear cell carcinoma ovarian
less response to chemo,
palliative care in ovarian ca
use PEG tube for nausea/vomiting control, use home hydration (not TPN), chemo will NOT remove obstruction unless platinum sensitive. brain/bone mets are not common. ascites may respond to bevacizumab.
platinum resistant disease - doublets??
NO data for doublets.
platinum sensitive disease- doublets?
combo is better (with carbo)
