ovarian

Question 1

interval debulking ovarian

Answer 1

not data driven

Question 2

optimal debulking ovarian

Answer 2

30% cure, PFS 23 mo, OS 52mo (with IP therapy, 66mo, with complete debunking 90mo)

Question 3

cis v. carbo for ovarian

Answer 3

no advantage of cis.

Question 4

IP chemo for ovarian

Answer 4

survival benefit stage III

Question 5

weekly taxol + q3wk carbo

Answer 5

improved survival compared to q3wk

Question 6

GOG0218- bevacizumab in early stage

Answer 6

no OS benefit, modest PFS benefit

Question 7

stage III ovarian optimally debulked

Answer 7

IP chemo! (IV an option if cannot)

Question 8

stage III - IV regimen

Answer 8

ddP (weekly) plus carbo has improved OS over q3wk. adding bev nullifies need for weekly. in US we don’t do the bev

Question 9

olaparib for ovarian

Answer 9

4rd line for later, BRCA mutant. risk of MDS/secondary malignancies, median 7-9 month PFS

Question 10

platinum sensitive v. resistant

Answer 10

6 months

Question 11

what do you do with rising CA125 with ovarian

Answer 11

you can use aromatase inhibitor or tamoxifen. early v. later doesn’t confer advantage

Question 12

secondary debulking? any benefit of debulking at relapse

Answer 12

MSKCC- if >12 month RFI, and complete excision possible, then consider. but not based on randomized data

Question 13

platinum sensitive recurrence

Answer 13

taxol to carbo, gem, or doxil

Question 14

platinum hypersensitivity

Answer 14

12% of pts, median 8 cycles, occur in latter 3rd of infusion, potentially life-threatening, you can prophlax, refer to allergist

Question 15

OCEANS study- bev for recurrence

Answer 15

PFS advantage of 4 months , no OS but high crossover,

Question 16

cediranib + chemo in platinum sensitive

Answer 16

modest PFS benefit, 3 month survival advantage

Question 17

response rates for recurrent ovarian

Answer 17

30% for sensitive, 10% ORR for resistant: etoposide, topotecan, gem, pemetrexid, doxil, vino, irino

Question 18

does it matter what chemo to give in ovarian recurrent

Answer 18

no

Question 19

CA125 response with chemo

Answer 19

you need to wait 3-4 cycles for response

Question 20

AURELIA study- bev for platinum resistance

Answer 20

chemo + bev in platinum resistant has doubling of response rate with taxol, gem, doxil, doubling of PFS. no survival advantage

Question 21

maintenance therapy with early stage ovarian debulked?

Answer 21

no? PFS advantage but no OS advantage with taxol. study ongoing for olaparib

Question 22

STIC

Answer 22

precursor to serous ovarian- p53+

Question 23

clear cell ovarian/endometriod ovarian

Answer 23

HNPCC. Clear cell has pI3k

Question 24

low grade serous ovarians

Answer 24

BRAF, KRAS, NRAS. maybe MEKi works.

Question 25

stage 1a grade 1/2 serous chemo treatment

Answer 25

observe only

Question 26

early stage ovarian (stage I) high risk

Answer 26

+washings, surgical spill/rupture, but no spread beyond ovaries. no advantage of 6 cycles versus 3 of adjuvant chemo. (GOG157),

Question 27

clear cell carcinoma ovarian

Answer 27

less response to chemo,

Question 28

palliative care in ovarian ca

Answer 28

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.

Question 29

platinum resistant disease - doublets??

Answer 29

NO data for doublets.

Question 30

platinum sensitive disease- doublets?

Answer 30

combo is better (with carbo)