Cancer Support Group

Saturday, Jul 11th

Last update:06:42:40 AM GMT

Case Discussion

Case 9
  • An 87 yrs old women is seen because of shortness of breath, abdominal pain & bloating. The patient has medication-controlled hypertention and adult-onset diabetes. She had minor stroke four yrs ago, from which she recovered completely. On examination, breath sounds are decreased at both lung bases,and there is marked ascites. CT of Abd. & Pelvis shows the presence of ascites & shows diffuse carcinomatosis. There is also large Pelvic Mass that is consistent with ovarian neoplasm. The CA-125 = 5700 U/ml. Ascitic tapping done with removal of 5 lit. of fluid. The Cytology is Adenocarcinoma.
  • Which of the following is the most appropriate next step in the treatment of this patient ?
Objectives
  1. A combination regimen consisting of a platinum agent & taxane, delivered without dose modification with GSSF.
  2. Single-agent carboplatin followed by paclitaxel if the response is inadequate.
  3. Single-agent paclitaxel.
  4. A regimen of carboplatin & taxane followed by high-dose chemotherapy.
  5. No chemotherapy.
Correct Answer
  1. A combination regimen consisting of a platinum agent & taxane, delivered without dose modification with GSSF.
  2. Single-agent carboplatin followed by paclitaxel if the response is inadequate.
  3. Single-agent paclitaxel.
  4. A regimen of carboplatin & taxane followed by high-dose chemotherapy.
  5. No chemotherapy.
Explanatory Answer
Data support single agent carboplatin is reasonable initial treatment option because of a low KPS, substantial comorbid medical conditions, or advanced age.

If disease does not respond to the platinum agent, a subsequent decision can be made about whether to use a second line cytotoxic agent or symptomatic/comfort measures only.

There is not justification for concluding that a women with a malignant disease consistant with ovarian cancer should be denied the opportunity to have clinically meaningful symptomatic benefit (anticipated response rate of 50% - 80%) from treatment based solely on her age.

Case 10
  • A 65 year old woman with stage III ovarian cancer has a CR following surgery and carboplatin and paclitaxel. Other than moderate fatigue, the patient tolerated the chemotherapy regimen without major side effects. Three years after the completion of primary chemotherapy, the patient has intermittent diffuse abdominal discomfort. Repeat CT demonstrates moderate ascites and possible small peritoneal implants. The CA-125 is 575 U/mL. The gynecologic oncologist does not believe that repeat surgery will be of any clinical value.
  • Which of the following treatment strategies would you recommend for this patient ?
Objectives
  1. Single-agent cisplatin.
  2. Single-agent carboplatin.
  3. Carboplatin and paclitaxel.
  4. Whole abdomen radiation therapy.
  5. A non-platinum-containing chemotherapy regimen.
Correct Answer
  1. Single-agent Cisplatin.
  2. Single-agent Carboplatin.
  3. Carboplatin and Paclitaxel.
  4. Whole abdomen radiation therapy.
  5. A non-platinum-containing chemotherapy regimen.
Explanatory Answer
Goals-Improve symptoms related to the disease, prolong the time to progression, and prolong overall survival.

Phase III trial of women with recurrent ovarian cancer indicate that the combination of carboplatin and paclitaxel leads to better DFS and OS (two-year survival 57% and 50%, respectively: p=0.02) than carboplatin alone.

The issue of neuropathy should not interfere with a recommendation & she should be given a regimen associated with a demonstrated survival benefit. No data are available to support the use of non-platinum based chemotherapy or WAR for this patient.


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