Ovarian cancer medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Huda A. Karman, M.D.

Overview

Medical therapies, such as chemotherapy and radiation, are often employed post-surgical therapy as a means to treat residual disease. The success of medical therapy often hinges on the histology of the tumor.

MedicalTherapy

  • Epithelial ovarian cancer includes ovarian, fallopian tube, and peritoneal cancer and the combination of the three is referred to as (EOC) due to the similarity in their clinical behavior and characteristics
  • EOC is usually diagnosed in its late stages due to its subclinical or nonspecific symptoms
  • The mainstay of definitive diagnosis and initial management of ovarian cancer is surgical operation to determine if it is benign or malignant, determine its stage and grade, and then treat it accordingly
  • The medical management of ovarian cancer is usually done as an adjuvant to the surgical therapy which means surgery first then adjuvant chemotherapy
  • Based on the surgical staging and grading of the tumor the management can be one of the following:
  • Five-year disease-free survival rates range from 40 to 80 percent
      • Is recommended for the following:
        • Early stage EOC with high-risk features:
        • Stage IC (Ovary plus positive peritoneal washing) or Stage II (involve pelvis) EOC
        • (clear cell histology
        • high tumor grade (grade 3)
    • First-line chemotherapy for advanced (stage III or IV) epithelial ovarian, fallopian tubal, and peritoneal cancer[5][6][7][8][9]
  • Chemotherapy is used after surgery to treat any residual disease, if appropriate. This depends on the histology of the tumor; some kinds of tumor (particularly teratoma) are not sensitive to chemotherapy. In some cases, there may be a reason to perform chemotherapy first, followed by surgery.
  • Many oncologists recommend intravenous (IV) chemotherapy including a platinum drug with a taxane as a preferred method of treating advanced ovarian cancer. However, three recent randomized studies clinical trials suggest that chemotherapy that is partly IV and partly via direct infusion into the abdominal cavity (intraperitoneal or IP) may improve median survival time.
  • IP chemotherapy generally has higher toxicity and its advantages are still debated among specialists.
  • Currently for Stage IIIC ovarian adenocarcinomas after optimal debulking, the median time for survival is statistically significantly longer for patient receiving intraperitoneal chemotherapy.
  • Patients in this clinical trial did report less compliance with IP chemotherapy, and fewer than half of the patients received all six cycles of IP chemotherapy.
  • Despite this high "drop-out" rate, the group as a whole (including the patients that didn't complete IP chemotherapy treatment) survived longer on average than patients who received intravenous chemotherapy alone. These results can be interpreted in a couple of ways. One could argue if the IP chemotherapy treatment group had completed the six cycles of chemotherapy their lives would have been prolonged even longer. Or the advantages of receiving IP chemotherapy are significant in the early phases of chemotherapy. Some specialists believe the IP chemotherapy toxicities will be unnecessary with improved IV chemotherapy drugs currently being developed.

References

  1. Young RC, Walton LA, Ellenberg SS, Homesley HD, Wilbanks GD, Decker DG; et al. (1990). "Adjuvant therapy in stage I and stage II epithelial ovarian cancer. Results of two prospective randomized trials". N Engl J Med. 322 (15): 1021–7. doi:10.1056/NEJM199004123221501. PMID 2181310.
  2. Ahmed FY, Wiltshaw E, A'Hern RP, Nicol B, Shepherd J, Blake P; et al. (1996). "Natural history and prognosis of untreated stage I epithelial ovarian carcinoma". J Clin Oncol. 14 (11): 2968–75. doi:10.1200/JCO.1996.14.11.2968. PMID 8918494.
  3. Chan JK, Tian C, Teoh D, Monk BJ, Herzog T, Kapp DS; et al. (2010). "Survival after recurrence in early-stage high-risk epithelial ovarian cancer: a Gynecologic Oncology Group study". Gynecol Oncol. 116 (3): 307–11. doi:10.1016/j.ygyno.2009.10.074. PMID 19944452.
  4. Chan JK, Tian C, Monk BJ, Herzog T, Kapp DS, Bell J; et al. (2008). "Prognostic factors for high-risk early-stage epithelial ovarian cancer: a Gynecologic Oncology Group study". Cancer. 112 (10): 2202–10. doi:10.1002/cncr.23390. PMID 18348296.
  5. Kyrgiou M, Salanti G, Pavlidis N, Paraskevaidis E, Ioannidis JP (2006). "Survival benefits with diverse chemotherapy regimens for ovarian cancer: meta-analysis of multiple treatments". J Natl Cancer Inst. 98 (22): 1655–63. doi:10.1093/jnci/djj443. PMID 17105988.
  6. Tewari D, Java JJ, Salani R, Armstrong DK, Markman M, Herzog T; et al. (2015). "Long-term survival advantage and prognostic factors associated with intraperitoneal chemotherapy treatment in advanced ovarian cancer: a gynecologic oncology group study". J Clin Oncol. 33 (13): 1460–6. doi:10.1200/JCO.2014.55.9898. PMC 4404424. PMID 25800756.
  7. Hess LM, Benham-Hutchins M, Herzog TJ, Hsu CH, Malone DC, Skrepnek GH; et al. (2007). "A meta-analysis of the efficacy of intraperitoneal cisplatin for the front-line treatment of ovarian cancer". Int J Gynecol Cancer. 17 (3): 561–70. doi:10.1111/j.1525-1438.2006.00846.x. PMID 17504373.
  8. Jaaback K, Johnson N, Lawrie TA (2016). "Intraperitoneal chemotherapy for the initial management of primary epithelial ovarian cancer". Cochrane Database Syst Rev (1): CD005340. doi:10.1002/14651858.CD005340.pub4. PMID 26755441.
  9. Walker JL, Brady MF, Wenzel L, Fleming GF, Huang HQ, DiSilvestro PA; et al. (2019). "Randomized Trial of Intravenous Versus Intraperitoneal Chemotherapy Plus Bevacizumab in Advanced Ovarian Carcinoma: An NRG Oncology/Gynecologic Oncology Group Study". J Clin Oncol. 37 (16): 1380–1390. doi:10.1200/JCO.18.01568. PMC 6544459 Check |pmc= value (help). PMID 31002578.

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