Ovarian Cancer

Question 1

Which mutations are commonly seen in high grade serous carcinoma

Answer 1

TP53, SMARCA4, HRD (ie. BRCA)

Question 2

Which mutations are commonly seen in mucinous carcinoma?

Answer 2

HER2, KRAS

Question 3

Which mutations are commonly seen in Low grade serous?

Answer 3

BRAF, KRAS (TP53 wild type)

Question 4

Which mutations are seen in clear cell ovarian cancer?

Answer 4

ARID1A, KRAS, PTEN and PIK3CA

Question 5

Which patients with ovarian cancer should be offered germline BRCA testing?

Answer 5

All patients with non mucinous ovarian cancer

Question 6

What percentage of HGSC have HRD?

Answer 6

50%

Question 7

What percentage of HGSC have a germline BRCA mutation?

Answer 7

15%

Question 8

Do BRCAm ovarian have a better or worse response to chemotherapy?

Answer 8

BRCAm predicts better response to platinum based chemo and improved survival

Question 9

What should be included for complete surgical staging in ovarian cancer?

Answer 9

Hysterectomy, BLSO, peritoneal biopsies, omentectomy and lymph node sampling

Question 10

When would you consider NACT?

Answer 10

If patients have a high risk peri-operative mortality or high risk of incomplete cytoreduction.

Question 11

Which adjuvant chemotherapy regime is used and what is the response rate?

Answer 11

6 cycles of 3 weekly carboplatin AUC5 and paclitaxel 175mg/m2, 70% response rate

Question 12

When are patients eligible for bevacizumab adjuvantly and when would it be started?

Answer 12

If presence of distant metastases or >1cm of residual disease. Bevacizumab to start alongside 2nd post op cycle of chemotherapy. Up to 18 doses.

Question 13

Which treatments are licensed for maintenance treatment in BRCAm HGSOC after partial or complete response to chemotherapy?

Answer 13

Olaparib or niraparib

Question 14

What maintenance strategy would you use for BRCAm HGSOC who are high risk

Answer 14

Niraparib or olaparib +- bevacizumab

Question 15

Which maintenance treatment would be used in a patient with a homologous repair proficient HGSOC

Answer 15

Bevacizumab or Niraparib

Question 16

Which maintenance treatment would be used in a patient with a homologous repair deficient HGSOC

Answer 16

Niraparib if low risk. If high risk niraparib, olaparib/bevacizumab

Question 17

How long can olaparib be used adjuvantly?

Answer 17

2 years but can be continued in residual disease that stays stable

Question 18

Define ‘platinum sensitive disease’

Answer 18

DFI of >12 months

Question 19

Define ‘partially platinum sensitive’

Answer 19

DFI of 6-12m

Question 20

Define ‘platinum resistant’

Answer 20

DFI <6 months

Question 21

Define ‘platinum refractory’

Answer 21

Progression during therapy or within 4 weeks of completion

Question 22

What would you define as biochemical progression

Answer 22

If Ca 125 has doubled

Question 23

When would you consider rechallenge with platinum chemotherapy

Answer 23

If DFI >4 months and favourable response to last platinum based chemotherapy

Question 24

What would be the first line treatment in platinum resistant disease?

Answer 24

Weekly paclitaxel

Question 25

What would be your first line treatment on relapse of platinum sensitive disease?

Answer 25

Carboplatin and pegylated liposomal doxorubicin (Caelyx) or alternative platinum double followed by maintenance rucaparib (if not had previous PARPi).

Question 26

When can olaparib be used in the relapsed setting?

Answer 26

Used as maintenance in platinum sensitive BRCAm patients following second platinum based chemotherapy regime if not had PARPi previously.

Question 27

Lifetime risk of ovarian cancer in BRCA1m?

Answer 27

45%

Question 28

Lifetime risk of ovarian cancer with BRCA2m?

Answer 28

17%

Question 29

Which PARPi is linked to photosensitivity?

Answer 29

Rucaparib

Question 30

Which PARPi is associated with HTN?

Answer 30

Niraparib

Question 31

What tumour markers is most useful to diagnose a granulosa cell tumour?

Answer 31

Inhibin

Question 32

What percentage of ovarian cancers are attributable to BRCA mutations?

Answer 32

15%

Question 33

What feature of a borderline ovarian cancer would upgrade it to a low grade epithelial carcinoma?

Answer 33

Presence of invasive implants (peritoneal)

Question 34

What feature of a borderline ovarian cancer would upgrade it to a low grade epithelial carcinoma?

Answer 34

Presence of invasive implants (peritoneal)

Question 35

Granulosa cell tumours are associated with which other malignancy and by which mechanism?

Answer 35

Endometrial as they increase oestrogen production resulting in endometrial proliferation.

Question 36

What is the most important independent prognostic factor or survival for a patient with ovarian cancer?

Answer 36

Resection of all macroscopic disease