Treatment and pre-meds

Question 1

Primary chemotherapy

Answer 1

Paclitaxel (175 mg/m2) over 3 hours THEN carboplatin (5X GFR+25) Q3 weeks X 6 cycles
Give paclitaxel first to decrease neurotoxicity. Give carboplatin instead of cisplatin to decrease infusion time, decrease N/V, decrease nephrotoxicity.
Give dexamethasone, aprepitant, and 5HT3 antagonist.
Paclitaxel greater neuropathy compared to docetaxel but LESS neutropenia, less edema.

Question 2

Stage I and II, grade 2 or 3 follow-up

Answer 2

Pelvic exam q2-4 months X 2 years then q6 months X 3 years

CA-125 levels with each visit, CBC annually

Question 3

Stage III and IV follow-up

Answer 3

Re-evaluation post 6 cycles
Progression: move to second line treatment
Remission: observation or further treatment

Question 4

Recurrent treatment

Answer 4

> 6 months: Paclitaxel/Carboplatin AGAIN, abdominal XRT
Dexamethasone, aprepitant, 5HT3 antagonist.
<6 months: Liposomal doxorubicin, topotecan, gemcitabine, investigational drugs

Question 5

Intraperitoneal chemotherapy

Answer 5

Population: <1 cm optimally debulked tumors, stage III, IV, II
Increases risk of infection, bowel adhesions, and patient discomfort but increases OS by 15 months!!
Paclitaxel (135 mg/m2) over 24 hours, Cisplatin 100 mg IP on D2, then Paclitaxel 60 mg IP on D8
Increases exposure 1000 fold.
Studied with CISPLATIN not carboplatin.