RT Book, Section
A1 Borders, Emily B.
A1 Smith, Judith A.
A2 DiPiro, Joseph T.
A2 Yee, Gary C.
A2 Posey, L. Michael
A2 Haines, Stuart T.
A2 Nolin, Thomas D.
A2 Ellingrod, Vicki
SR Print(0)
ID 1182475379
T1 Ovarian Cancer
T2 Pharmacotherapy: A Pathophysiologic Approach, 11e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781260116816
LK accesspharmacy.mhmedical.com/content.aspx?aid=1182475379
RD 2024/04/19
AB KEY  CONCEPTS  Ovarian  cancer  is  denoted  “the  silent  killer”  because  of  the  nonspecific  signs  and  symptoms  that  contribute  to  the  delay  in  diagnosis.  The  few  patients  who  present  with  disease  still  confined  to  the  ovary  will  have  a  5-year  survival  rate  greater  than  90%,  but  most  patients  present  with  advanced  disease  and  have  a  5-year  survival  rate  of  10%  to  30%.  Ovarian  cancer  is  a  sporadic  disease  with  less  than  10%  of  cases  of  ovarian  cancer  attributed  to  heredity.  However,  a  history  of  two  or  more  first-degree  relatives  with  ovarian  cancer  increases  a  woman’s  risk  of  developing  ovarian  cancer  by  greater  than  50%.  Considerable  education  efforts  have  been  made  to  identify  patients  with  the  persistence,  greater  than  2  weeks,  of  nonspecific  presenting  symptoms  of  ovarian  cancer  including:  abdominal  pressure/pain,  difficulty  eating  or  feeling  full  quickly,  urinary  urgency/frequency,  change  in  bowel  habits,  or  unexplained  vaginal  bleeding.  CA-125  is  a  nonspecific  antigen  used  as  a  tumor  marker  for  diagnosis  and  monitoring  epithelial  ovarian  carcinoma.  If  CA-125  is  positive  at  the  time  of  diagnosis,  changes  in  CA-125  levels  correlate  with  disease  response  and  progression.  Although  most  patients  will  achieve  a  complete  response  to  initial  treatment,  more  than  50%  of  patients  will  have  recurrence  within  the  first  2  years.  If  recurrence  occurs  less  than  6  months  after  completion  of  chemotherapy,  the  tumor  is  defined  to  be  platinum-resistant.  The  antitumor  activity  of  second-line  chemotherapy  regimens  is  similar,  and  the  choice  of  treatment  for  recurrent  platinum-resistant  ovarian  cancer  depends  on  residual  toxicities,  physician  preference,  and  patient  convenience.  Participation  in  a  clinical  trial  is  also  a  reasonable  option  for  these  patients.  Ovarian  cancer  is  staged  surgically  with  the  International  Federation  of  Gynecology  and  Obstetrics  (FIGO)  staging  algorithm.  Tumor-debulking  and  total  abdominal  hysterectomy–bilateral  oophorectomy  surgery  are  the  primary  surgical  interventions  for  ovarian  cancer.  After  the  completion  of  the  staging  and  primary  surgical  treatment,  the  current  standard  of  care  is  six  cycles  of  a  taxane/platinum-containing  chemotherapy  regimen.  The  intraperitoneal  (IP)  route  of  chemotherapy  administration  has  significantly  improved  progression-free  and  overall  survival,  but  patients  must  be  carefully  selected.  A  platinum-containing  doublet  chemotherapy  regimen  is  the  standard  of  care  for  the  first  recurrence  of  platinum-sensitive  ovarian  cancer.  Despite  recent  advances,  enrollment  in  an  investigational  study  is  still  the  primary  treatment  recommendation  for  patients  with  recurrent  platinum-resistant  ovarian  cancer.  The  activity  of  the  new  class  of  the  poly(adenosine  diphosphate  [ADP]-ribose)  polymerase  (PARP)  inhibitors  in  the  maintenance  treatment  of  recurrent  or  refractory  advanced  ovarian  cancer  depends  on  BCRA  status  or  “BRCAness”  of  the  tumor.