Ovarian (includes fallopian tube and primary peritoneal)

Question 1

screening

VIDEO**

Answer 1

PLCO trial shows evidence of HARM for low risk pts

no mortality difference

Question 2

role of surgery

Answer 2

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

Question 3

cytoreduction definitions (3pts) - OS depends on this

Answer 3

microscopic: no visible
optimal: 1cm

OS depends on this

Question 4

role of adjuvant combination chemo -5

Answer 4

primary tx for ALL stages

Question 5

LIMITED TO OVARY=STAGE 1

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

Answer 5

determined by stage AND histology= favorable vs unfavorable

Question 6

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

SOME CALL THIS STAGE III-IV, but not NCCN

Answer 6

ALL CYCLES q21d x6

Question 7

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

Answer 7

PFS 28 vs 17

Question 8

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

Answer 8

TOC: guidelines read offer to ALL pts who qualify

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

Question 9

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

Answer 9

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

Question 10

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

Answer 10

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

Question 11

which cycle can you start bev?

Answer 11

C2 (need time for surgery wound healing)

Question 12

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

Answer 12

chemo for ALL unlike comprehensive staging, IV or IP

Question 13

recurrent dz - general principles (5pts)

Answer 13

60-80% relapse

Question 14

when to initiate tx following CHEMICAL recurrence?

Answer 14

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

Question 15

prognosis and tx defined by initial response to tx

Answer 15

platinum/taxane sensitive: treatment free interval > 6mo

p/t resistant: TFI <6mo

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

Question 16

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

cat 2A if not listed

Answer 16

pac + platinum (cat 1)

Question 17

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

Answer 17

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

Question 18

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

Answer 18

consider in pt’s with pre-existing neuropathy

Question 19

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

Answer 19

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

Question 20

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

Answer 20

HTN, proteinuria, and GI events more common for bev

UNLIKE adjuvant bev which is ONLY HTN

Question 21

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

Answer 21

single agent, sequential tx

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

Question 22

bev GI tox

Answer 22

sx of severe enterocolitis - diffuse inflammation throughout entire GI tract

IF DEVELOPS STOP DRUG

Question 23

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

Answer 23

may be intermittent or complete