Ovarian Cancer Flashcards
What are some of the risk factors for ovarian cancer?
Advanced age, low parity/infertility, family history, early menarche, late menopause, endometriosis
What are some of the hereditary syndromes that are assoc with ovarian cancer? What are the gene mutations?
Hereditary breast and ovarian syndrome (BRCA1/2), Lynch Syndrome, Peutz Jeghers (STK11 gene), Nevoid Basal Cell Carcinoma (PTCH1), Ollier Disease (IDH1/2)
After undergoing surgery for Stage IA/B with grade 1 and 2 endometrioid disease what adjuvant tx do they receive?
For patients with grade 1-observation. Grade 2 pathology you can either observe (recommended in ASCO) or you can give chemotherapy.
What is the adjuvant treatment for Stage IA/B disease with grade 2 pathology (serous/endometrioid)?
You can either observe or you can give adjuvant chemo so either is an acceptable answer.
What is the adjuvant tx patients with Stage IC (serous/endometrioid) disease require?
All of these patients will need adjuvant chemo, this stage is where is malignant cells have spread outside of the ovary in some way, refer to staging system.
For stages II, III, and IV Ovarian cancer generally speaking what adjuvant tx will they need?
Adjuvant chemo of course, can also add Bevacizumab. Maintenance options will be bevacizumab if used upfront w/chemo or you can do a Parp inhibitor for those with BRCA 1/2 mutations (germline or somatic). You can combine Bevacizumab w/ Olaparib or Nirapirib.
If patients w/ Stages II-IV have a BRCA mutation and received Bevacizumab upfront what is the ideal maintenance regimen they should receive?
They should at the minimum be on a parp inhibitor and not Bevacizumab alone. You can combine Bevacizumab with Nirapirib and Olaparib, but not Rucaparib. Or you can do just one of these 3 agents alone.
If for patients with Stages II-IV are BRCA neg and they received upfront Bevacizumab, what other test do you need to check and what do they receive based off of this?
You need to check the HRD status. If they are deficient you give Bev+Olaparib (Cat 1 rec), Bev+Nirapirib (only if they can’t tolerate Olaparib), or you can give Bevacizumab alone. If HRD proficient, then you just give Bevacizumab.
What is the survival benefit when adding Bevacizumab to upfront and maintenance therapy?
It helps improve PFS, but it hasn’t been shown to consistently offer a OS benefit. Those with Stage IV or inoperable Stage III or suboptimally debulked Stage III may receive the highest benefit.
For those with Stages II-IV who got surgery and need maintenance therapy, what are the maintenance options for those who did not receive Bevacizumab upfront?
If BRCA mutation is neg you can give Olaparib, Nirapirib, or Rucaparib. If germline/somatic mutation is positive, you give Olaparib, Nirapirib (Cat 1 rec for both) or Rucaparib. It says you can observe for select cases of Stage II with a CR. Remember you give these options for those who have a partial or complete response.
How do Parp inhibitors work?
They prevent the repair of single stranded breaks in DNA in homologous recombination deficiencies.
What is the maintenance regimen recommended for those patients who received Bevacizumab upfront with chemo and are BRCA neg, but HRD positive?
You can give Olaparib w/Bev or Nirapirib with Bev or you can do Bevacizumab alone
What are the side effects seen with Olaparib?
AML, MDS, VTE, PE, pneumonitis, pancytopenia (mild thrombocytopenia), GI side effects, joint pain
What are some side effects seen with Nirapirib?
AML/MDS, pancytopenia, AKI, intestinal obstruction/perforation, HTN, LFT increase, GI side effects
What is the time interval used in ovarian cancer recurrence to see if a patient is platinum sensitive or not?
Anything that recurs prior to 6 months they are considered platinum resistant otherwise they can use a platinum agent again.
