Ovarian Cancer Flashcards
Which mutations are commonly seen in high grade serous carcinoma
TP53, SMARCA4, HRD (ie. BRCA)
Which mutations are commonly seen in mucinous carcinoma?
HER2, KRAS
Which mutations are commonly seen in Low grade serous?
BRAF, KRAS (TP53 wild type)
Which mutations are seen in clear cell ovarian cancer?
ARID1A, KRAS, PTEN and PIK3CA
Which patients with ovarian cancer should be offered germline BRCA testing?
All patients with non mucinous ovarian cancer
What percentage of HGSC have HRD?
50%
What percentage of HGSC have a germline BRCA mutation?
15%
Do BRCAm ovarian have a better or worse response to chemotherapy?
BRCAm predicts better response to platinum based chemo and improved survival
What should be included for complete surgical staging in ovarian cancer?
Hysterectomy, BLSO, peritoneal biopsies, omentectomy and lymph node sampling
When would you consider NACT?
If patients have a high risk peri-operative mortality or high risk of incomplete cytoreduction.
Which adjuvant chemotherapy regime is used and what is the response rate?
6 cycles of 3 weekly carboplatin AUC5 and paclitaxel 175mg/m2, 70% response rate
When are patients eligible for bevacizumab adjuvantly and when would it be started?
If presence of distant metastases or >1cm of residual disease. Bevacizumab to start alongside 2nd post op cycle of chemotherapy. Up to 18 doses.
Which treatments are licensed for maintenance treatment in BRCAm HGSOC after partial or complete response to chemotherapy?
Olaparib or niraparib
What maintenance strategy would you use for BRCAm HGSOC who are high risk
Niraparib or olaparib +- bevacizumab
Which maintenance treatment would be used in a patient with a homologous repair proficient HGSOC
Bevacizumab or Niraparib
Which maintenance treatment would be used in a patient with a homologous repair deficient HGSOC
Niraparib if low risk. If high risk niraparib, olaparib/bevacizumab
How long can olaparib be used adjuvantly?
2 years but can be continued in residual disease that stays stable
Define ‘platinum sensitive disease’
DFI of >12 months
Define ‘partially platinum sensitive’
DFI of 6-12m
Define ‘platinum resistant’
DFI <6 months
Define ‘platinum refractory’
Progression during therapy or within 4 weeks of completion
What would you define as biochemical progression
If Ca 125 has doubled
When would you consider rechallenge with platinum chemotherapy
If DFI >4 months and favourable response to last platinum based chemotherapy
What would be the first line treatment in platinum resistant disease?
Weekly paclitaxel
What would be your first line treatment on relapse of platinum sensitive disease?
Carboplatin and pegylated liposomal doxorubicin (Caelyx) or alternative platinum double followed by maintenance rucaparib (if not had previous PARPi).
When can olaparib be used in the relapsed setting?
Used as maintenance in platinum sensitive BRCAm patients following second platinum based chemotherapy regime if not had PARPi previously.
Lifetime risk of ovarian cancer in BRCA1m?
45%
Lifetime risk of ovarian cancer with BRCA2m?
17%
Which PARPi is linked to photosensitivity?
Rucaparib
Which PARPi is associated with HTN?
Niraparib
What tumour markers is most useful to diagnose a granulosa cell tumour?
Inhibin
What percentage of ovarian cancers are attributable to BRCA mutations?
15%
What feature of a borderline ovarian cancer would upgrade it to a low grade epithelial carcinoma?
Presence of invasive implants (peritoneal)
What feature of a borderline ovarian cancer would upgrade it to a low grade epithelial carcinoma?
Presence of invasive implants (peritoneal)
Granulosa cell tumours are associated with which other malignancy and by which mechanism?
Endometrial as they increase oestrogen production resulting in endometrial proliferation.
What is the most important independent prognostic factor or survival for a patient with ovarian cancer?
Resection of all macroscopic disease