Second line chemotherapy for ovarian cancer
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This document discusses second line chemotherapy options for ovarian cancer. It defines platinum-sensitive and platinum-resistant disease based on platinum-free interval. For platinum-sensitive disease, retreatment with the same regimen or a combination is recommended over single agent. Bevacizumab added to chemotherapy improves outcomes for platinum-resistant disease. While further lines of therapy can improve survival, patient performance status must be considered.
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1. The document discusses prophylactic cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) in high-risk patients for peritoneal carcinomatosis. It covers topics like the peritoneum, mechanisms of peritoneal dissemination, cytoreduction, HIPEC, high-risk patients, FDG-PET scanning, and second-look surgery.
2. Second-look surgery found peritoneal carcinomatosis in 56% of high-risk patients, who had a 5-year survival rate of 90% after complete cytoreduction and HIPEC.
3. While showing promise, the study had some weaknesses like its sample size and criteria for considering patients as high-
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Second line chemotherapy for ovarian cancer
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Gi Cancer Symposium 2012 Report Presentation
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bens_presentation.ppt
Mr. PR, a 58-year-old male, presented with changes in bowel habits and anemia. Further investigation revealed stage IV rectal cancer with liver and lung metastases. He received FOLFOX chemotherapy with bevacizumab, showing an excellent response. He was then switched to maintenance capecitabine and bevacizumab. Clinical trials demonstrate that bevacizumab improves outcomes when added to first-line chemotherapy for metastatic colorectal cancer. However, it should not be combined with anti-EGFR agents in patients with KRAS wild-type tumors.
What’s the Latest in Clear Cell Ovarian Cancer?
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recent advances in management of inflammatory bowel diseases
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Important trials of 2016
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1) A study of grade 2 gliomas in young patients found that progression-free survival and overall survival were longer for those who received radiation therapy plus chemotherapy compared to radiation therapy alone.
2) A prostate cancer study found that among men with localized prostate cancer, survival was similar for those undergoing surveillance with PET-CT scans compared to planned neck dissection, but surveillance resulted in fewer operations and was more cost-effective.
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Dr. Gail Eckhardt
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CHERYL RYDER, ARNP, WOMEN’S CANCER ASSOCIATES
Metastatic breast cancer
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3) For post-menopausal women with incidental adnexal masses found on imaging, unilocular cysts under 10cm have a very low risk of cancer but should be monitored with serial ultrasounds; complex masses require further evaluation.
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This document discusses ovarian cancer prevention. It notes that ovarian cancer risk increases with age and factors like family history and endometriosis. Screening is not recommended for average risk women as trials found it did not reduce mortality and caused harm. Two main types of ovarian cancer have different origins - type II tumors often originate in the fallopian tubes. Prevention strategies discussed include risk-reducing salpingo-oophorectomies, oral contraceptives, metformin, NSAIDs, vitamins, and physical activity, which may reduce inflammation and hormones linked to cancer.
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Ovarian cancer has a poor prognosis because it is often diagnosed at an advanced stage. Screening average risk women is not recommended as randomized trials found no decrease in mortality. Screening high risk women with annual CA-125 and transvaginal ultrasound may detect some early stage cancers but also has many false positives. The UKCTOCS trial found the multimodal screening strategy of combining CA-125 interpreted through ROCA and ultrasound had higher sensitivity and positive predictive value than ultrasound alone. Final mortality data from this large trial is still pending in 2015.
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Librarians are leading the way in creating future-ready citizens – now we need to update our spaces to match. In this session, attendees will get inspiration for transforming their library spaces. You’ll learn how to survey students and patrons, create a focus group, and use design thinking to brainstorm ideas for your space. We’ll discuss budget friendly ways to change your space as well as how to find funding. No matter where you’re at, you’ll find ideas for reimagining your space in this session.
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Chapter-1
Introduction to objective, scope and outcome the subject
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Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
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Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
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Chapter 6
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Second line chemotherapy for ovarian cancer
- 1. Second Line Chemotherapy for Ovarian Cancer Dr. Shadi Alkhayyat. MBBS,FRCPC Assistant Professor Of Medicine and Oncology. King Abdulaziz University
- 2. • Definitions. • Defining Recurrence. • Discussion will be limited to Epithelial Ovarian Cancer. • Platinum-Sensitive Ovarian Cancer • Platinum-Resistant Ovarian Cancer
- 3. • Relapse is common in ovarian cancer. • Up to 60%. • Platinum-Free Interval: 1- Predictor for response to chemotherapy. 2- Prognostic factors for PFS and OS. 3- Predictor for outcome with cytoreduction.
- 4. Platinum-Free Interval Platinum-Sensitive Disease • Interval is 6 months or more Platinum-Resistant Disease • Interval is less than 6 months. • Progression while on chemotherapy (Refractory ovarian cancer)
- 5. Relapse • CA 125 is used to follow patient with ovarian cancer. • Serologic relapse. • Early versus Delayed treatment. 1- No survival difference. 2- Worse quality of life.
- 6. MRC OV05/EORTC 55955 Rushtin G,Volume 376, No. 9747, p1155–1163, 2 October 2010
- 7. Platinum-Sensitive Disease • Retreatment with same protocol. • Combination is superior to single agent. • Secondary cytoreduction. • Multiple combinations Carboplatin and Paclitaxel Carboplatin and Liposomal doxorubicin Carboplatin and Gemcitabine.
- 8. Gynecologic Cancer Intergroup • ORR 47% Vs 31% • PFS 8.6 m Vs 5.8 m • OS 18m Vs 17.3m
- 12. CALYPSO Trial • PFS 11.3m Vs 9.4m • OS 33m Vs 31m • Equivalent data with less side effects.
- 13. CALYPSO Trial
- 14. Trabectedin • If platinum can not be used, combination of Liposomal doxorubicin and Trabectedin is an option. • OVA-301 showed better ORR, PFS with no difference on OS.
- 15. Patients who are not candidate for combination chemotherapy • Single agent showed good response. • Multiple agent are approved 1- Topotecan 2- Gemcitabine. 3- Liposomal Doxorubicin 4- Trabectedin 5- Nab-Paclitaxel
- 16. Role of Bevacizumab • Bevacizumab is an angiogenic inhibitor. • Ovarian cancer expresses VEGF and VEGF receptors. • In GOG 170D, Bevacizumab shows response as single agent.
- 17. OCEAN Trial
- 18. OCEAN Trial
- 19. • Adding Bevacizumab is not standard of care. • Criticism of the chemotherapy backbone.
- 20. Platinum-Resistant Disease • Single agent is more preferable. • Bevacizumab has better role in combination. • Cochrane review: Paclitaxel Liposomal Doxorubicin Topotecan • Depends on Initial therapy, side effects profile.
- 21. • Other single agent used are: Gemcitabine Etoposide Docetaxel Pemetrexate
- 22. Role of Bevacizumab • As monotherapy, GOG 170D had limited number who showed response. • In ASCO 2012, Bevacizumab showed significant improve in ORR and PFS.
- 23. AURELIA Study
- 24. AURELIA Study
- 25. AURELIA Study Progression-free SurvivalOverall Response Rate 10 months Vs 4 months52% Vs 29%Paclitaxel 6 months Vs 2 months23% Vs 3%Topotecan 5 months Vs 4 Months18% Vs 8%Liposomal Doxorubicin
- 26. Combination Chemotherapy • In GINECO trial, Paclitaxel Platinum Resistant Cancer Paclitaxel and Topotecan Paclitaxel and Carboplatin
- 27. • Overall response rate similar. • Progression-Free Survival not different • Febrile neutropenia increased 4- times in combination arm.
- 28. How long to continue therapy? • Survival improved with chemotherapy compared to best supportive care. Overall Survival BSC Overall Survival Chemotherapy Line of Chemotherapy 4 months14 monthsSecond Line 3 months11 monthsThird Line 3 months8 monthsFourth Line
- 29. • Hormonal therapy: Fulvestrant, Tamoxifen or Letrozole. • Targeted therapy.
- 30. Take home • Relapse is common in ovarian cancer. • Platinum-Free Interval • Cytoreduction • Platinum Sensitive Disease: Combination is superior to single agent. Retreatment is usually successful.
- 31. • Platinum Resistant Disease: Single agent depending on initial chemotherapy and side effects. Adding Bevacizumab to single chemotherapy improve survival and response. • Further lines improve survival. • Patient performance status need to be considered