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Fellows 2021! > Ovary > Flashcards

Ovary Flashcards

1
Q

Mean time to recurrence after primary treatment

A

18 months

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2
Q

What fraction of epithelial ovarian cancers (EOC) are high vs low grade?

A

2/3 HGSC, 1/3 LGSC

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3
Q

Main histological types of EOC

A

serous, clear cell, endometrioid, mucinous, other (brenner, transitional cell, etc.)

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4
Q

Staging procedure for ovarian cancer

A

TAH, BSO, omentectomy, PPALND, biopsies (anterior and posterior cul de sac, left and right pelvis, left and right paracolic gutters, left and right diaphragm), and washings

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5
Q

What additional surgical procedures do you do if a mucinous tumor is identified?

A

Appendectomy

Make sure colonoscopy is UTD

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6
Q

Histological types of EOC associated with Lynch syndrome?

A

Clear cell, endometrioid

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7
Q

Histological types of EOC associated with BRCA?

A

Serous

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8
Q

Ovarian stage I

A

I - limited to ovaries or tubes
IA - limited to one ovary/tube, capsule intact
IB - limited to both ovaries/tubes, capsule intact
IC - limited to one or both ovaries/tubes, with positive cytology
IC1 - surgical spill
IC2 - capsule rupture before surgery, or tumor on surface of ovary or tube
IC3 - positive washings

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9
Q

Ovarian stage II

A

II - extension below the pelvic brim, or primary peritoneal (within the pelvis)
IIA - extension/implants to uterus or surface of tubes/ovaries
IIB - extension/implants to other pelvic tissues (sigmoid, bladder, peritoneum etc)

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10
Q

Ovarian stage III

A

III - metastases outside the pelvis
IIIA1 - positive RP LNs only (i - up to 10mm, ii >10mm)
IIIA2 - microscopic extrapelvic peritoneal involvement +/- positive RP LNs
IIIB - macroscopic peritoneal metastasis beyond pelvis up to 2cm, +/- positive RP LNs
IIIC - macroscopic peritoneal metastasis beyond the pelvis >2 cm, +/- positive RP LNs (includes extension to capsule of liver and spleen without parenchymal involvement)

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11
Q

Ovarian stage IV

A

IV - distant metastases
IVA - malignant pleural effusion
IVB - liver or splenic parenchymal metastases, metastases to extra-abdominal organs (inguinal LNs), transmural involvement of the intestine

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12
Q

AURELIA

A

Adding bevacizumab to single-agent chemotherapy improves PFS in PR recurrent ovarian cancer.

Chemo (paclitaxel, topotecan, doxil) +/- bevacizumab
Inclusion: recurrent PR ovarian cancer
Exclusion: >2 prior regimens, refractory dz, hx bowel obstruction/perf/fistula
Median PFS: 6.7 vs 3.4 months (SS)
ORR: 30.9% vs 12.6% (SS)
Adverse effects: higher rates HTN and GI perf w/ bev

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13
Q

Options for platinum resistant recurrence

A

AURELIA ([taxol or topotecan or doxil] + bev)

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14
Q

PS/PR/PRef ?

A

> 6 months or <6 months to progression, or progression on treatment

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15
Q

Options for platinum sensitive recurrence

A

OCEANS (carbo/gem/bev), CALYPSO (carbo/doxil)

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16
Q

OCEANS

A

Gemcitabine/carboplatin plus bevacizumab followed by bevacizumab maintenance extends PFS compared to gemcitabine/carboplatin alone in PS recurrent ovarian cancer.

Gem 1000 D1,8 + Carbo AUC 4 D1 q21d x6
Plus: bevacizumab 15 or placebo
Inclusion: first recurrence PS, measurable dz
Exclusion: prior VEGF, hx GI perf/fistula/obstruction, surgery w/i 28d
PFS: 12.4 (bev) vs 8.4 months (SS)
ORR: 78.5% vs 57.4% (SS)
Duration of Response: 10.4 vs 7.4 mos (SS)
OS: 33.3 vs 35.2 mos (NS)
Bev: worse HTN and proteinuria

17
Q

CALYPSO

A

Carbo/Doxil is non-inferior to Carbo/Taxol in recurrent PS ovarian cancer with a favorable side effect profile.

Carbo AUC 5 + Taxol 175 q3w x6
Carbo AUC 5 + Doxil 30 q4w x6
Inclusion: measurable disease, 1-2 prior lines, PS
Exclusion: preexisting cardiomyopathy or neuropathy
PFS: 11.3 (CD) vs 9.4 (CT) months (SS)
CD: worse thrombocytopenia, N/V (SS)
CT: worse alopecia, neutropenia (SS)

18
Q

PAOLA-1

A

Olaparib added to frontline bevacizumab maintenance prolonged PFS in unselected cohort with advanced ovarian cancer. Greatest benefit in BRCAm or HRD patients. (Not for HR-proficient.)

Bev maintenance +/- olaparib 300mg (or placebo)
Inclusion: HGSC or endometrioid ovarian cancer, primary treatment with bev resulting in NED/CR/PR
Exclusion: delays due to hematologic toxicity
PFS all: 22.1 vs 16.6 months (SS)
PFS BRCAm: 37.2 vs 21.7 (SS)
PFS HRD: 28.1 vs. 16.6 (SS)
PFS HR proficient/unknown: 16.9 vs. 16.0 (NS)
Anemia, fatigue, nausea more common in olaparib arm.

19
Q

PRIMA

A

Treatment with niraparib maintenance improved PFS in all considered populations, including the whole cohort.

Placebo vs niraparib 300/200mg
Inclusion: Stage III/IV HGSC or endometrioid, prior platinum tx with CR/PR
PFS HRD: 21.9 vs 10.4 months (SS)
PFS HRD/BRCAm: 22.1 vs 10.9 months (SS)
PFS HRD/BRCAwt: 19.6 vs 8.2 months (SS)
PFS HR-proficient: 8.1 vs 5.4 months (SS)
PFS: 13.8 vs 8.2 months (SS)
Grade >3 adverse events: 70.5% vs 18.9% (most common: anemia, thrombocytopenia, neutropenia)

20
Q

GOG 218

A

Chemotherapy plus bevacizumab followed by bevacizumab maintenance improved PFS by 4 mos in advanced stage ovarian cancer after surgical resection.

1 - Carbo AUC 6 + Taxol 175 + bev + placebo mt
2 - Carbo AUC 6 + Taxol 175 + bev + bev mt
3 - Carbo AUC 6 + Taxol 175 + placebo + placebo mt
Inclusion: Stage III with any residual, and Stage IV
Exclusion: borderline, recurrent, prior RT
PFS: 11.2 vs 14.1 vs 10.3 months (SS)
OS: NS. HTN: 16.5% vs 22.9% vs 7.2% (SS)

21
Q

GOG 158

A

Carbo/paclitaxel is not inferior to cis/paclitaxel with regard to PFS in patients with optimally resected, stage III epithelial ovarian cancer.

Ctrl: cisplatin 75 + paclitaxel 135 (over 24hrs) q21d x6
Exp: carbo AUC 7.5 + paclitaxel 175 (over 3hrs) q21d x6
Inclusion: stage III, optimally cytoreduced (<1cm)
PFS and OS not SS. Completion of 6 cycles similar.
Carbo/taxol less grade 3/4 leukopenia, GI, renal, metabolic toxicities, but more thrombocytopenia than cis/taxol (SS)

22
Q

Optimal/suboptimal debulking

A

complete - no residual disease
optimal - <1cm remaining disease
suboptimal - >1cm disease remaining

Fellows 2021! (10 decks)

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