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- 2. Epidemiology 225000 new incidence annually worldwide. Incidence stable since 1970s 1600 new cases in Australia in
- 3. Stage at diagnosis and 5-yr survival Stage I Confined to the Ovary 20% 85% IA Growth
- 4. Subtypes Epithelial High grade serous 75% Mucinous 10% Endometrioid 10% Clear cell Low grade serous Germ
- 5. Ovarian Cancer Risk Factors 50 years of age or older Familial factors Family history of breast,
- 6. Ovarian Cancer and Early Detection Certain factors may reduce a woman's risk of developing ovarian cancer
- 7. Lifetime Risk of Cancers Associated With Specific Genes *MMR (mismatch repair) = HNPCC. Chen S, et
- 8. Red Flags for Cancer Susceptibility: BRCA1/BRCA2 Multiple family members with ovarian or breast cancer Age of
- 9. Natural History Precise natural history is poorly understood There is no direct evidence for a premalignant
- 10. Ovarian Ca Screening for general population: PLCO trial 68557 participants 55-74yo w/o prior hx of oophorectomy
- 11. Ovarian Ca screening in ‘high risk grp’ UKFOCCS Phase 1: annual Ca125 and TVUS Sensitivity >80%,
- 12. Ovarian Ca screening Major organisations do not recommend ovarian cancer screening: Poor understanding of natural history
- 13. Management of Ovarian Cancer SURGICAL STAGING AND DEBULKING
- 14. Initial Surgical management Surgery is usually performed upfront regardless of stage: Obtain tissue diagnosis Perform surgical
- 15. Steps in Surgical Staging
- 17. Stage I And II OC: role of adjuvant chemotherapy 8% 5 year improvement in OS was
- 18. Adjuvant Rx for early stage Ovarian Ca NCCN guideline suggests adjuvant chemo in stage 1C or
- 19. Postop Management of advanced ovarian cancer
- 20. Standard: ?Carbo AUC6 + Pacli GOG 111 and OV10: Cisp/Paclitaxel v Cisp/Cyclo showed 11% ARR favouring
- 21. Improving outcome beyond Carbo/Paclitaxel First line Carbo/Paclitaxel showed RR 70-80% with more than 50% achieving CR
- 22. Better schedule for Carbo/Pacli JCOG 3016 trial Lancet 2009;374:1331-1338 637 pts stage II to IV (65%
- 23. Better carbo/taxol schedule MITO-7 JCO 2013;31 suppl;abstr LBA5501 822 pts stage IC to IV (66% SIII,
- 24. ADDING THIRD CYTOTOXIC Rationale: addition of non-cross resistant drug to platinum/paclitaxel combi may improve OS Multiple
- 25. Role of targeted agents: pazopanib AGO-OVAR16: Pazopanib (24m) v placebo in pts who do not have
- 26. Role of Bevacizumab GOG 218: carbo/paclitaxel v CP+Bev 15mg/kg v CP+Bev->Bev 12m maintenance only managed to
- 27. Role of intraperitoneal chemotherapy Rationale: direct delivery of drug into peritoneal cavity increase the dose intensity
- 28. Neoadjuvant chemotherapy
- 29. Consider in women with extensive disease and poor ECOG. No consensus on who should receive NACT.
- 30. Neoadjuvant chemo: MRC CHORUS 550 Pts stage III to IV. 72 centres in UK and 2
- 31. Recurrent ovarian cancer
- 32. Current Questions in Recurrent Disease How do you define recurrence? Physical exam Imaging Chemical When do
- 33. 264 236 203 167 129 103 69 53 38 31 19 265 247 211 165 131
- 34. Pros & Cons of Treating CA-125 Increase Cons Potential Rx of false positives No improvement in
- 35. Primary Treatment End of Frontline Therapy 0 Mos 6 Mos 12 Mos Refractory Resistant Sensitive Platinum
- 36. Recurrent Ovarian Cancer: Effect of Platinum-Free Interval and Survival Days Percentage Pujade-Lauraine E, et al. ASCO
- 37. 1978 Cisplatin Carboplatin Altretamine Paclitaxel Topotecan Liposomal doxorubicin (PLD) (accelerated) Liposomal doxorubicin (full) Gemcitabine (with carboplatin)
- 38. Positive Trials in Recurrent Ovarian Cancer Paclitaxel vs topotecan[1,2] Topotecan vs pegylated liposomal doxorubicin (PLD)[3,4] Platinum
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