(精选)【医学英文课件】 Ovarian cancer update教学课件.pptVIP

HOW TO CHOOSE AGENT ABLE TO PREDICT WHO WILL RESPOND BRCA STATUS NEXT GEN SEQUENCING LOOKING FOR BIOMARKER LOSS OF HETEROZYGOSITY 40+ GENES INVOLVED IN HR DEFICIENCY (PTEN) MULTIPLE LINES OF THERAPY ALTERNATE chemo agents Ovarian cancer update Kentucky cancer Registry 9/8/2016 Erica Takimoto, D.O., F.A.C.O.O.G. Gynecologic Oncology My Aunt Kris Diagnosed 9/2013 -22,800 estimated new cases -1.3% of all cancer cases - 14,240 deaths Ovarian cancer in 2016 Insidious onset Bloating Increased abdominal girth Pelvic mass on CT/US/MRI No good screening test – CA 125, OVA1 Clinical acumen is paramount Family history Symptoms diagnosis -Localized (15%) Confined to Primary Site -Regional (19%) Spread to Regional Lymph Nodes -Distant (60%) Cancer Has Metastasized -Unknown (6%)Unstaged Ovarian cancer in 2016 Five year survival of 46.2% Ovarian cancer in 2016 CT scan image CT scan image Intraoperative findings of ovarian cancer -Recent change in definition of “optimal” to No Visible Residual Disease (NRD) or “R0” -With previous definition of 1cm, approx 75% of pts -With new goal of NRD, approx 25% of pts -Initially suggested by German Study and validated by Rob Coleman et al Primary Therapy Primary Therapy -New data suggests Neoadjuvant Chemotherapy (NAC) beneficial in certain conditions (EORTC, SEER, CHORUS) -Key decision point in patients with new diagnosis -Will impact OS -NCCN / ASCO / SGO - all EOC pts need BRCA status VUS treated as negative -TAXANE / PLATINUM DOUBLET -CARBOPLATIN AUC 6 -TAXOL 175MG/M2 OR WEEKLY DOSE DENSE 80MG/M2 -INTRAPERITONEAL -GOG172 -PATHOLOGIC CR WITH NAC IS LOW – 5% PRIMARY THERAPY Frontline SOC SWOG -TAXOL 175MG/M2 Q28D -3 VS 12 CYCLES -PFS IMPROVED FOR 12C -28 VS 21 MOS PRIMARY THERAPY MAINTENANCE Recurrence -THE PROBLEM OF RECURRENCE -WITHIN FIRST 6 MOS – RESISTANT -GREATER THAN 6 MOS – SENSITIVE -TYPICAL SCENARIO -10-12 mos relapse -5-6 mos relapse CAVEATS -PLATIN