Ovarian (includes fallopian tube and primary peritoneal) Flashcards

1
Q

screening

VIDEO**

A

PLCO trial shows evidence of HARM for low risk pts

no mortality difference

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2
Q

role of surgery

A

primary tx for ALL stages, by trained gyn-onc surgeon

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3
Q

cytoreduction definitions (3pts) - OS depends on this

A

microscopic: no visible
optimal: 1cm

OS depends on this

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4
Q

role of adjuvant combination chemo -5

A

primary tx for ALL stages

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5
Q

LIMITED TO OVARY=STAGE 1

adjuvant chemo by stage - early stage I-II - comprehensive surgical staging -6

A

determined by stage AND histology= favorable vs unfavorable

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6
Q

adjuvant chemo - advanced dz (stage II-IV) NCCN regimens -6

SOME CALL THIS STAGE III-IV, but not NCCN

A

ALL CYCLES q21d x6

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7
Q

Dose dense study: pac 80 over 1h D1,8,15 +carbo 6 D1 (cat 1) vs pac/carbo D1 - adv dz JAPANESE -4

A

PFS 28 vs 17

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8
Q

Armstrong trial: IP chemo: pac 135 over 24h D1 +cis 75-100 IP D2 +pac 60 IP D8 (cat 1) vs pac 135 over 24h +cis 75 (this reg no longer used) - OPTIMAL, stage III -adv dz AND ADR -4

A

TOC: guidelines read offer to ALL pts who qualify

#IP arm significantly more toxic: 
(leukop, thrombocytop, GI, fatigue, metabolic, pain, fever, infx, renal)
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9
Q

IP chemo - pt selection - adv dz (5pts)

A

Stage IIIC, optimal, adjuvant

no rectosigmoid bowel resection at time of primary tx

none or minimal prior pelvic surgery (if lots of adhesions in bowel chemo does not distribute well)

good PS

<65 yo

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10
Q

GOG-218: pac 175 over 3h +carbo 6 +bev 7.5-15 add C2-6 +bev 7.5-15 q21d another 12-17C (cat 3) vs +bev for C2-6 only vs placebo bev for C2-6 - included SUBOPTIMAL, stage III-IV - adv dz

-6

A

PFS 14.1 vs 11.2 vs 10.3 (sig) (needed bev MAINTENANCE to see difference, can not give just C2-6)

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11
Q

which cycle can you start bev?

A

C2 (need time for surgery wound healing)

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12
Q

adjuvant chemo by stage - early stage I-II - inadequate surgical staging

A

chemo for ALL unlike comprehensive staging, IV or IP

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13
Q

recurrent dz - general principles (5pts)

A

60-80% relapse

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14
Q

when to initiate tx following CHEMICAL recurrence?

A

NCCN: follow CA-125 q3-4mo if elevated pre-op

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15
Q

prognosis and tx defined by initial response to tx

A

platinum/taxane sensitive: treatment free interval > 6mo

p/t resistant: TFI <6mo

p/t refractory: no response or progression on primary tx

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16
Q

platinum/ taxane sensitive dz - 1st line (9pts)

cat 2A if not listed

A

pac + platinum (cat 1)

17
Q

ICON4/AGO: pac + platinum (cat 1) -platinum/ taxane sensitive dz - 1st line

A

vs platinum alone showed sig PFS and OS (only study to show OS improvement)

18
Q

AGO-EORTC: gem + platinum (“acceptable alternative”) -platinum/ taxane sensitive dz - 1st line

A

consider in pt’s with pre-existing neuropathy

19
Q

CALYPSO: peg lipo doxo +carbo -platinum/ taxane sensitive dz - 1st line

A

hypersensitivity reactions MUCH less vs comparator of pac-carbo

nobody knows why, but impt as many pt’s develop hypersensitivity with carbo over months of admin

20
Q

OCEANS: gem +carbo +bev (cat 2b) -platinum/ taxane sensitive dz - 1st line

A

HTN, proteinuria, and GI events more common for bev

UNLIKE adjuvant bev which is ONLY HTN

21
Q

platinum/ taxane resistant or refractory dz OR 2nd recurrence of p/t sensitive dz - (16pts including 3 pts of general concepts)

A

single agent, sequential tx

#altretamine
#bev
#cyclophos
#doce
#etop
#gem
#nab-pac
#oxal
#pac (weekly)
#peg lipo doxo
#tam
#topotecan
#vinorelbine
22
Q

bev GI tox

A

sx of severe enterocolitis - diffuse inflammation throughout entire GI tract

IF DEVELOPS STOP DRUG

23
Q

end stage ovarian CA - supportive care - bowel obstruction -6

A

may be intermittent or complete