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Fall 2021: Therapeutics III > Therapeutics of Ovarian Cancer (Weddle) > Flashcards

Therapeutics of Ovarian Cancer (Weddle) Flashcards

1
Q

Explain the “incessant ovulation” theory.

A

That ovarian cancer risk is related to number of ovulatory cycles

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2
Q

List some risk factors for ovarian cancer.

A
  • early menarche, late menopause
  • increased age
  • nulliparity
  • in vitro fertilization
  • 2+ 1st degree relatives with ovarian cancer
  • BRCA1/2, p53
  • Lynch II syndrome (HNPCC)
  • Caucasian
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3
Q

What are some factors that decrease risk of ovarian cancer?

A
  • multiple pregnancies
  • prolonged oral contraceptive use
  • prophylactic oophorectomy
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4
Q

___________________ represents > 90% of ovarian cancer cases.

A

epithelial adenocarcinoma

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5
Q

What are the five subtypes of ovarian cancer?

A
  • serous
  • endometrioid
  • mucinous
  • clear cell (worse prognosis)
  • sex cord stromal tumors
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6
Q

What is the current screening tool for ovarian cancer?

A

there is no effective screening tool

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7
Q

How should women at low risk for ovarian cancer be screened?

A

annual physical and pelvic exam

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8
Q

How should women at high risk for ovarian cancer be screened?

A

pelvic exam, transvaginal ultrasound, and CA-125 blood test every 6-12 months (starting age 25-35)

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9
Q

Why do most ovarian cancer patients tend to present with advanced-stage disease?

A

because stage I and II are typically asymptomatic

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10
Q

What symptoms may present with advanced ovarian cancer?

A
  • ascites
  • pleural effusion
  • constipation
  • small bowel obstruction
  • nausea/vomiting
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11
Q

What is involved in a diagnostic work-up for ovarian cancer?

A
  • H&P
  • pap smear
  • transvaginal ultrasound
  • abdominal CT, chest x-ray
  • colonoscopy
  • CBC, serum chemistries, CA-125
  • exploratory laparotomy
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12
Q

How is ovarian cancer staged?

A

surgically

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13
Q

What is the standard, 1st line approach to treating ovarian cancer?

A

surgery + adjuvant therapy

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14
Q

What does it mean if a patient is classified as “optimally debulked”?

A

< 1 cm of disease remaining

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15
Q

What does it mean if a patient is classified as “sub-optimally debulked”?

A

> 1 cm of disease remaining

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16
Q

Which stage of ovarian cancer does not need adjuvant chemotherapy?

A

IA/IB grade 1; just observe and follow-up every 3 months

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17
Q

What is the current standard of adjuvant chemotherapy for ovarian cancer?

A

paclitaxel and carboplatin every 3 weeks

18
Q

Elimination of carboplatin closely mirrors ___________.

A

GFR

19
Q

Why is the GYN/ONC cancer population extra susceptible to hypersensitivity reactions?

A

chemotherapeutic agents used (paclitaxel, docetaxel, carboplatin, cisplatin) and exposure to multiple chemotherapy cycles

20
Q

What is a type I hypersensitivity?

A

occurs with initial contact

21
Q

What is the mechanism of type I hypersensitivity?

A

cross-linking to mast cells and basophils which trigger release of histamine and other inflammatory mediators

22
Q

What is a type II hypersensitivity?

A

occurs with repeated exposure to an agent

23
Q

What is the mechanism of type II hypersensitivity?

A

T-cells recognize antigens

24
Q

What symptoms are associated with type I hypersensitivity?

A

anaphylaxis, itching, rash, chest tightness

25
Q

What symptoms are associated with type II hypersensitivity?

A

erythema, induration (infusional type reactions)

26
Q

Which chemo hypersensitivity culprits are actually often infusion-related reactions?

A

paclitaxel (Cremophor) and liposomal doxorubicin

27
Q

List some common symptoms of infusion-related toxicity.

A
  • flushing
  • redness
  • tingling
  • headache
  • shortness of breath
  • abdominal/chest pain
28
Q

Most paclitaxel hypersensitivity reactions manifest as type __.

A

I

29
Q

What are the three standard pre-medications that can be used to avoid hypersensitivity reactions to paclitaxel?

A
  • dexamethasone
  • diphenhydramine
  • famotidine
30
Q

Carboplatin hypersensitivity can best be described as type IV. What is type IV?

A

delayed reaction occuring when antigen-sensitized cells release cytokines after subsequent contact

31
Q

What are the two aims of intraperitoneal chemotherapy for stage IIIC ovarian cancer?

A

increased tumor exposure and decreased systemic toxicity

32
Q

Patients with tumors ______ cm tend to respond best to intraperitoneal chemotherapy.

A

< 2

33
Q

What qualifications make a patient a good candidate for intraperitoneal chemotherapy?

A
  • stage III
  • good performance status
  • normal renal function
  • no previous problems that could worsen during chemo (i.e., preexisting neuropathy)
  • no hx of bowel surgery/resection
34
Q

What toxicities are prevalent in ovarian cancer patients treated with adjuvant bevacizumab therapy?

A

hypertension and GI perforations

35
Q

Give an example of a PARP inhibitor.

A

olaparib, rucaparib, niraparib

36
Q

Which PARP inhibitor should be used as maintenance after 1st line chemo for germline or somatic BRCA mutations?

A

olaparib (Lynparza)

37
Q

Which PARP inhibitor should be used as maintenance after 1st line chemo in patients regardless of BRCA status?

A

niraparib (Zejula)

38
Q

What are the two most common toxicities amongst all PARP inhibitors?

A

fatigue, anemia (also N/V)

39
Q

What does it mean when a patient is platinum sensitive?

A

they have relapsed > 6 months following completion of their initial platinum-containing regimen

40
Q

What are the treatment options for a platinum sensitive patient?

A

can be treated with the initial chemo regimen again; re-use paclitaxel/carboplatin

41
Q

What does it mean when a patient is platinum resistant?

A

the patient has relapsed < 6 months after receiving a platinum-containing regimen

42
Q

What does it mean if a patient is platinum progressive/refractory?

A

they have shown no response/progression of disease during primary therapy with paclitaxel/carboplatin

Fall 2021: Therapeutics III (25 decks)

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