Ovarian Cancer Flashcards
What is etiology of Ovarian Cancer?
- Cause unknown
- Mutations [BRAC 1 =25-45%; BRAC 2 = 30%]
What is the pathogenesis of Ovarian Cancer?
- “Incessant Ovulation” - number of ovulatory cycles that results in disruption and repair of the epithelial lining
What are some of the risk factors for Ovarian Cancer?
- # of ovulatory cycles
- Age
- Kids?
- Genetics [BRAC 1 & 2]
What are some of the the ways that we could decrease the risk factors for Ovarian Cancer?
- Multiple pregnanies
- ORAL contraceptives
- Oophorectomy [remove ovaries]
Why is Ovarian Cancer known as the “Silent Killer”?
- Stage I and II is asymptomatic - DONT KNOW THEY HAVE IT
- Leading to advanced disease [70%]
What are some of the Clinical Presentations for Ovarian Cancer?
- Bloating, Fatigue, Indigestion, Increased Urination, Pelvic Pain, constipation
- Lasting more than 12 or more days of a month for 2 months GO TO DOCTOR
What is the initial treatment that should be used in Ovarian Cancer?
- CURE
- Surgery + Adjuvant Chemo [70-90% will recur]
What are some thing that should be done to help with determining Ovarian Cancer Treatment?
- Genetic Evalution
- BRCA or HRD can help determine
What is Homologous Recombination Deficiency within Ovarian Cancer?
- 50% of ovarian carcinomas - defect in one or more genes
What is the treatment overview for Ovarian Cacner?
- +/- neoadjuvant platinums
- Surgery or not [ALWAYS A ROLE]
- Adjuvant platinums
- Maintenance [PARPs]
- RELAPSE [restart chemo]
- recurrent therapy
- Maintenance [PARPs]
What is important to know about Surgery in Ovarian Cancer?
- “Debunking” - removing as much cancerous tissue from the abdomen to < 1cm [OPTIMAL]
- Sub-optimal = > 1cm
What is adjuvant chemotherapy for Ovarian Cancer?
- NOT in stage I or II [observation]
- ALL OTHER STAGES [Paciltaxel x3h + Carboplatin x21d]
What is the way that we determine the Carboplatin dosing in Adjuvant Chemo for Ovarian Cancer?
- Calvert Equation = AUC x (GFR + 25)
- AUC ~ 5-7.5
What are some of the most common agents to cause Hypersensitivity reactions in Ovarian Cancer?
- PACLITAXEL [Cremophor], docetaxel, carboplatin, cisplatin
- NEED DESENSITIZATION [slowly infuse drug]
What is Type I Hypersensitivity in Ovarian Cancer?
- immediate response to drug
- Anaphylaxis, Itching, rash, chest tightness
What Type IV Hypersensitivity in Ovarian Cancer?
- Repeated exposure to the drug - T cells recognize antigens
- Erythema [skin redness], Induration [thicken soft tissue]
What is important to know about Paclitaxel in Hypersensitivity in Ovarian Cancer?
- COMMON - 30% [Type I]
- Due to Cremophor
What is important to know about the Taxane Infusion Reactions in Hypersensitivity in Ovarian Cancer?
- Direct effect on immune cells during the 1st or 2nd exposure
- Flushing, Back Pain, Chest tightness
What are some of the ways that we are able to avoid the problems with Paclitaxel in Ovarian Cancer?
- Steroid + H1 + H2
- Dexamethasone + Diphenhydramine + Famotidine [Anaphylactic Kit]
What is important to know about Docetaxel and Albumin Bound Paclitaxel reaction in Ovarian Cancer?
- Docetaxe: Polysorbate 80
- Albumin Bound Paclitaxel: Human Albumin
What is important to know about Carboplatin Hypersensitivity in Ovarian Cancer?
- Occurs after multiple cycles - 7 CYCLE [Type IV]
- Can cause vomiting, hypotension
What can be used as maintenance therapy in Ovarian Cancer?
- Bevacizumab or PARP Inhibitors
What is important to know about PARP inhibitors in Ovarian Cancer?
- MOA: Forms double strand DNA breaks in BRCA cells and prevents DNA repair = cell death
- OlaPARib, RucePARib, NiraPARib
What is PARP?
- Helps repair the Single and Double Stranded DNA breaks [can increase Cancer survival]
- PARP Inhibitors STOP repair
What PARP inhibitors are used for Maintenacne after platinum respone? What are used in Recurrent Ovarian Cancer?
- Platinum: Olaparib [BRCA] & Niraparib [No BRCA]
- Recurrent: Olaparib [No BRCA], Niraparib [BRCA], Rucaparib [BRCA]
What are some of the important monitoring parameters for PARP inhibitors in Ovarian Cancer?
- CBC monitoring & Renal Function [Olaparib]
What are some of the adverse effects in PARP inhibitors in Ovarian Cancer?
- Anemia, Neutropenia, Thrombocytopenia
What is important to know aobut Metastatic Ovarian Cancer?
- NO LONGER CURE
- no standard of therapy
What is Recurrence within Ovarian Cancer?
- Relapses > 6 months following completion = “Platinum Sensitive” [can use plats again]
- Relapses < 6 months following platinums = “Platinum Resistant” [never responded]
What is the treatment for the recurrences in Ovarian Cancer?
- Sensitive: Paclitaxel/Carboplatin again
- Resistant: Non-Platinums [Cyclophophamide, Docetaxel…]
- Clinical trails
EXAMPLE: What is the 1st line chemotherapy for someone with Stage III Ovarian Cancer?
- Paclitaxel + Carboplatin x6 cycles
- Surgery
EXAMPLE: What would be the 1st choice for treatment for recurrent Ovarian Cancer?
- WHEN?
- > 6 = same chemo [Paclitaxel + Carboplatin]
- <6 = Switch to non-platinum agent
EXAMPLE: What is the role of maintenance therapy in Ovarian Cancer?
- PARP Inhibitors
- Olaparib [BRCA] or Narapinib [NO BRCA] –> Chemo –> Maintenance with PARP
