Ovarian Cancer

Question 1

In 58% of cases the cancer has metastasized

a. true
b. false

Answer 1

a. true

Question 2

Age >= __ is a risk factor for ovarian cancer

Answer 2

70

also menopause is a risk factor

Question 3

Late pregnancy >= __ years old is a risk factor for ovarian cancer

Answer 3

35

also nulliparity and ovarian stimulation with in-vitro fertilization are risk factors

Question 4

A family history of breast cancer is a risk factor for ovarian cancer

a. true
b. false

Answer 4

a. true

Question 5

Estrogen without progesterone for >= __ years is a risk factor for ovarian cancer

Answer 5

10

Question 6

Which makes up most ovarian cancer?

a. epithelial adenocarcinoma
b. germ cell tumors
c. sex cord stromal tumors
d. metastatic

Answer 6

a. epithelial adenocarcinoma

Question 7

What grade is poorly differentiated?

a. grade 1
b. grade 2
c. grade 3

Answer 7

c. grade 3

Grade 1: well differentiated
Grade 2: moderately differentiated
Grade 3: poorly differentiated

Question 8

There is no effective screening for ovarian cancer

a. true
b. false

Answer 8

a. true

Question 9

Use of oral contraceptives >= __ years is preventative for ovarian cancer

Answer 9

5

Question 10

Breastfeeding for how long is preventative for ovarian cancer?

Answer 10

> 1 year

Question 11

What laboratory marker is indicative of ovarian cancer?

Answer 11

CA-125

Question 12

Optimal cytoreduction with surgery is < __cm residual

Answer 12

1

suboptimal is > 1cm residual

Question 13

When to consider neoadjuvant chemotherapy?

Answer 13

for bulky stage III-IV if optimal cytoreduction not likely or poor surgical candidate

Question 14

Ovarian cancer chemo consists of what taxanes and platinums?

Answer 14

paclitaxel or docetaxel + carboplatin or cisplatin

Question 15

___ may be added to paclitaxel + carboplatin for stage I-IV adjuvant?

Answer 15

bevacizumab

Question 16

Pegylated liposomal doxorubicin frequency?

Answer 16

q4 weeks

Question 17

Regimens with paclitaxel or docetaxel + carboplatin frequency?

Answer 17

q3 weeks

Question 18

What AUC is moderate emetic risk with carboplatin?

Answer 18

< 4

> = 4 is high

Question 19

How is carboplatin dosed?

Answer 19

using Calvert formula (AUC)

total dose = target AUC x (GFR + 25)

Question 20

Up to 44% of pts on carboplatin have hypersensitivity reactions.

a. true
b. false

Answer 20

a. true

Question 21

Bevacizumab dosing is by __

a. AUC
b. mg/kg

Answer 21

b. mg/kg

first dose infused over 90 mins; 2nd dose 60mins; 3rd dose 30mins

Question 22

Hold bevacizumab for __ weeks before debunking to decrease post-op complications

Answer 22

6

Question 23

Bleeding and decreased wound healing is initiated in which cycle of bevacizumab?

Answer 23

cycle 2

Question 24

Monitor what throughout bevacizumab therapy?

Answer 24

urine protein

Question 25

Intraperitoneal chemo is used for what age?

Answer 25

<=65

Question 26

Intraperitoneal chemo is used for what stage ovarian cancer?

Answer 26

stage III (< 1cm residual)

Question 27

Aggressive __ regimens should be given before intraperitoneal therapy a. oral/IV hydration b. anti-emetic c. a and b

Answer 27

c. a and b aggressive hydration is given before and after

Question 28

IP chemo schedule modification to __ hours decreases toxicity

Answer 28

3

Question 29

Olaparib is given with what other drug if utilized in primary maintenance therapy?

Answer 29

bevacizumab

Question 30

Bevacizumab should not be continued if utilized in primary therapy if no progression a. true b. false

Answer 30

b. false may be continued

Question 31

What is recurrent treatment dictated by?

Answer 31

duration of first remission ``` duration of first remission platinum sensitivity prior toxicities convenience QOL insurance ``` first remission is always the longest

Question 32

Recurrent ovarian cancer: Platinum sensitive pts need platinum free interval of > __ months

Answer 32

6 platinum resistant < 6 months platinum refractory: no response on platinum therapy

Question 33

Tumor molecular testing is recommended prior to initiation of recurrent ovarian cancer therapy a. true b. false

Answer 33

a. true BRCA 1/2 and micro satellite instability (MSI) or DNA mismatch repair (MMR)

Question 34

Treatment for platinum resistant/refractory recurrent ovarian cancer?

Answer 34

liposomal doxorubicin +/- bevacizumab Also: - paclitaxel +/- bevacizumab - topotecan +/- bevacizumab - docetaxel - etoposide oral - gemcitabine

Question 35

Treatment for platinum sensitive recurrent ovarian cancer?

Answer 35

carboplatin/gemcitabine +/- bevacizumab Also: - carboplatin/paclitaxel +/- bevacizumab - carboplatin/liposomal doxorubicin +/- bevacizumab

Question 36

The PARP inhibitors are targeted therapy for both platinum sensitive and resistant ovarian cancer a. true b. false

Answer 36

a. true

Question 37

Recurrent Tx options: Olaparib is FDA indicated after >= __ lines of prior chemotherapy BRCA germline

Answer 37

3 Rucaparib >= 2 niraparib >= 3

Question 38

Patients who achieve partial response or complete response to platinum based therapy should receive a PARP inhibitor regardless of BRCA status a. true b. false

Answer 38

a. true olaparib rucaparib niraparib

Question 39

___ is olaparib toxicity a. hypertension b. palpitations c. hypercholesterolemia d. pneumonitis

Answer 39

d. pneumonitis

Question 40

___ is niraparib toxicity a. hypertension b. palpitations c. hypercholesterolemia d. pneumonitis select two

Answer 40

a, b

Question 41

__ is rucaparib toxicity a. hypercholesterolemia b elevates AST/ALT c. pneumonitis d. hypertension select two

Answer 41

a, b

Question 42

Surgery is standard of care for all stages of ovarian cancer a. true b. false

Answer 42

a. true