Treatment Flashcards
How do you counsel patients regarding IP therapy?
Overall survival was increased by 16 months GOG 172. (65.6 versus 49.7 months). Only 42% could complete six cycles
What stage do you recommend IP therapy?
Stage III, optimally debulked. Stage II may also receive although no randomized trials for stage II.
Do you offer Avastin?
Data from two phase 3 randomized trials (GOG 218, Icon7) did not show improved overall survival or quality-of-life did show a modest increase in progression free survival. And if you use it, you should use maintenance Avastin
Do you give maintenance chemotherapy?
The results of GOG 178 showed that patients receiving taxol for 12 months after initial therapy had a PFS advantage but with higher toxicity. Not powered for OSHowever another study did not show that it was beneficial. 212 pending( now no evid)
Ina biochemical recurrence of Ca125 what is the median time for clinical relapse?
Two – six months
What do you offer platinum – resistant disease?
Single agent, response rates: Doxil, 26% Etoposide, 27% Gemzar, 19% Topotecan 27% Weekly Taxol, 21% Taxotere 22%
You offer secondary cytoreduction?
Patients with long disease-free interval (six months or more), 2 to 3 sites of recurrence, ability to be cytoreduced, no ascites. Eisenkop showed medial survival was 44.4 mo, morbidity of 32%, and mortality of 2%, ability to optimally cytoreduce in 82%
Do you treat LMP w invasive implants?
These pts portends a less favorable prognosis and so generally they are treated with chemo( ip vs ip?)
The benefit of post o chemo after complete resection hasnot been well established
For LMP tumors, what is the percentage of upstaging?
Staging with omentectomy and multiple biopsies may upstage patients and 30% of the cases and they affect prognosis
What is the evidence for standard chemotherapy for advanced ovarian cancer?
The standard of CT is based on several studies: GOG 111 and OV 10 established that taxol substituted for cytoxan was superior when combined with cisplatin. Hog 158 demonstrated that carbo can be substituted cisplatin ( not inferior)
Is triplet therapy better than the standard carboplatinum and paclitaxel
GOG 182: looked at five arm trial with triplet therapy vs CT. Found no difference
NACT:
EORTC 55971: no overall survival difference (30 mo). Critics say this is inferior to survival in US, but possibly bc these pts were sicker
Do you treat w dose dense?
GOG 262 ongoing
JGOG showed improved PFS
Low grade ovarian cancer treatment?
No prospective trials. Retrospective reviews show that upfront debulking w max ctlytoreductive surgery is strongest predictor of prolonged survival. Response to chemo is inferior. For recurrence: bristow showed secondary debulking if optimal had OS of 56 mo
what is the role for second look surgery?
In the absence of randomized data confering survival benefit, it is not routinely done. 30-50% of stage III/IV will have a negative SLL. Debulking at SLL is controversial. Hoskins found survival advantage for pt without residual disease, but other studies could not replicate. So it may be reasonable to proceed if you can optimally debulk with little anticipated complications.
