Ovarian Cancer

Question 1

Which patients with ovarian cancer should be screened for BRCA or HNPCC?

Answer 1

Everyone

Question 2

What is stage II ovarian cancer?

Answer 2

Confined to pelvis.
IIA - uterus/fallopian tube

Question 3

What is stage III

Answer 3

spread to abdomen or RP LNs

Question 4

What does optimal debulking mean?

Answer 4

At most 10 mm of remaining tumor after surgery

Question 5

If a patient isn’t a candidate for optimal debulking surgery, what is the other treatment strategy?

Answer 5

Neoadjuvant chemo and interval debulking

Question 6

What is the preferred adjuvant chemotherapy regimen?

Answer 6

Carbo + Taxol

Question 7

If someone receives neoadjuvant chemotherapy and interval debulking surgery, what else can be done to improve PFS?

Answer 7

HIPEC

Question 8

Features of High risk early stage (3)

Answer 8

Stage IC or II
Clear cell histology
Grade 3 tumors, any histology

Question 9

Treatment for high risk Stage I or II ovarian cancer

Answer 9

Upfront debulking surgery and adjuvant carbo + taxol

Question 10

What is the definition of persistent disease?

Answer 10

Recurrence within 3 months

Question 11

What is the definition of platinum resistant disease?

Answer 11

Recurrence within 3-6 months

Question 12

Treatment for recurrent disease for relapse after >6 months since Carbo+Taxol (6)

Answer 12

Carbo/Gem
Carbo/Taxol
Carbo/Doxil
Above plus Bev

Question 13

Treatment for platinum resistant recurrent disease? (2)

Answer 13

Topotecan + Bev
Taxol + Bev

Question 14

Mirvetuximab MoA

Answer 14

Folate receptor antagonist

Question 15

Only Treatment to show OS benefit in platinum resistant ovarian cancer

Answer 15

Mirvetuximab

Question 16

What is the role of PARPi in ovarian cancer?

Answer 16

Only as maintenance therapy for BRCA1/2mut
Can be given with bev in adjuvant setting too

Question 17

Indication for mirvetuximab

Answer 17

FRA-positive (>75% of cells) platinum resistant disease

Question 18

Treatment for local low grade serous ovarian cancer

Answer 18

Surgery then adjuvant carbo+taxol. Consider sequential anti-estrogen

Question 19

Preferred treatment for recurrent low grade serous ovarian carcinoma

Answer 19

Trametinib

Question 20

Which ovarian pathology is analogous to seminoma?

Answer 20

Dysgerminoma

Question 21

Treatment for Stage IA dysgerminoma

Answer 21

USO, no adjuvant chemo

Question 22

Preferred chemotherapy for dysgerminoma for patients that need it

Answer 22

BEP

Question 23

Treatment for endodermal sinus/yolk sac tumor

Answer 23

USO
Adjuvant BEP (for all stages)

Question 24

Histology showing Call-Exner Bodies that look liek “starry sky” is what tumor?

Answer 24

Granulosa cell tumor

Question 25

Which ovarian tumor cause virilization?

Answer 25

Sertoli-Leydig cell tumor

Question 26

Adjuvant treatment for stage IA or IV low grade serous ovarian carcinoma after optimal debulking

Answer 26

Observation

Question 27

Adjuvant Treatment for Stage I granulosa cell tumors

Answer 27

Observation

Question 28

Adjuvant treatment for Stage III-IV granulosa cell tumor?

Answer 28

Carbo/Taxol

BEP can be considered

Question 29

Maintenance teratment for patients who are BRCA1/2 wild type and had good response to carbo/taxo/bev?

Answer 29

Bev maintenance

Question 30

Maintenance treatment for patients with HRD+ disease, BRCA1/2 wild type, with good response to carbo/taxol/bev

Answer 30

Bev + Olaparib

Less good options: Olaparib, Rucaparib, niraparib

Question 31

Maintenance treatment for patients who are BRCA1/2 wild type and had good response to Carbo/Taxol

Answer 31

Observation

Question 32

Maintenance treatment for patients with BRCA mutation who had a good response to Carbo/Taxol

Answer 32

Olaparib
Niraparib
Rucaparib

Question 33

Maintenance therapy for Stage II-III low grade serous carcinoma

Answer 33

Letrozole

Question 34

When to consider secondary cytoreduction surgery (4)

Answer 34

Recurrence >6 months
Good PS
Isolated focus of disease amenable to resection
Absence of ascites