Ovarian Cancer Flashcards
Which patients with ovarian cancer should be screened for BRCA or HNPCC?
Everyone
What is stage II ovarian cancer?
Confined to pelvis.
IIA - uterus/fallopian tube
What is stage III
spread to abdomen or RP LNs
What does optimal debulking mean?
At most 10 mm of remaining tumor after surgery
If a patient isn’t a candidate for optimal debulking surgery, what is the other treatment strategy?
Neoadjuvant chemo and interval debulking
What is the preferred adjuvant chemotherapy regimen?
Carbo + Taxol
If someone receives neoadjuvant chemotherapy and interval debulking surgery, what else can be done to improve PFS?
HIPEC
Features of High risk early stage (3)
Stage IC or II
Clear cell histology
Grade 3 tumors, any histology
Treatment for high risk Stage I or II ovarian cancer
Upfront debulking surgery and adjuvant carbo + taxol
What is the definition of persistent disease?
Recurrence within 3 months
What is the definition of platinum resistant disease?
Recurrence within 3-6 months
Treatment for recurrent disease for relapse after >6 months since Carbo+Taxol (6)
Carbo/Gem
Carbo/Taxol
Carbo/Doxil
Above plus Bev
Treatment for platinum resistant recurrent disease? (2)
Topotecan + Bev
Taxol + Bev
Mirvetuximab MoA
Folate receptor antagonist
Only Treatment to show OS benefit in platinum resistant ovarian cancer
Mirvetuximab
What is the role of PARPi in ovarian cancer?
Only as maintenance therapy for BRCA1/2mut
Can be given with bev in adjuvant setting too
Indication for mirvetuximab
FRA-positive (>75% of cells) platinum resistant disease
Treatment for local low grade serous ovarian cancer
Surgery then adjuvant carbo+taxol. Consider sequential anti-estrogen
Preferred treatment for recurrent low grade serous ovarian carcinoma
Trametinib
Which ovarian pathology is analogous to seminoma?
Dysgerminoma
Treatment for Stage IA dysgerminoma
USO, no adjuvant chemo
Preferred chemotherapy for dysgerminoma for patients that need it
BEP
Treatment for endodermal sinus/yolk sac tumor
USO
Adjuvant BEP (for all stages)
Histology showing Call-Exner Bodies that look liek “starry sky” is what tumor?
Granulosa cell tumor
Which ovarian tumor cause virilization?
Sertoli-Leydig cell tumor
Adjuvant treatment for stage IA or IV low grade serous ovarian carcinoma after optimal debulking
Observation
Adjuvant Treatment for Stage I granulosa cell tumors
Observation
Adjuvant treatment for Stage III-IV granulosa cell tumor?
Carbo/Taxol
BEP can be considered
Maintenance teratment for patients who are BRCA1/2 wild type and had good response to carbo/taxo/bev?
Bev maintenance
Maintenance treatment for patients with HRD+ disease, BRCA1/2 wild type, with good response to carbo/taxol/bev
Bev + Olaparib
Less good options: Olaparib, Rucaparib, niraparib
Maintenance treatment for patients who are BRCA1/2 wild type and had good response to Carbo/Taxol
Observation
Maintenance treatment for patients with BRCA mutation who had a good response to Carbo/Taxol
Olaparib
Niraparib
Rucaparib
Maintenance therapy for Stage II-III low grade serous carcinoma
Letrozole
When to consider secondary cytoreduction surgery (4)
Recurrence >6 months
Good PS
Isolated focus of disease amenable to resection
Absence of ascites
