Raw Links: Ovarian Cancer

Stanford Hospital Cancer Physicians
UCSF Medical Center Cancer Specialists

National Cancer Institute, Comprehensive Cancer Centers, Clinical Trials, Cancer Trials Support Unit,
NCI's Clinical Trials Cooperative Group Program

1. TRINOVA-3: A Study of AMG 386 or AMG 386 Placebo in Combination With Paclitaxel and Carboplatin to Treat Ovarian Cancer
2. Bevacizumab (Avastin), American Society of Clinical Oncology (ASCO)
Stanford Cancer Institute, Clinical Research Groups, Gynecology, Eligibility Flowcharts Gynecologic Cancer

National Comprehensive Cancer Network, NCCN Member Institutions, Guidelines with Evidence Blocks
NCI Ovarian Cancer Treatments - Intraperitoneal Therapy, Angiogenesis Inhibitors (Bevacizumab)
* Bevacizumab in combination with chemotherapy for the treatment of advanced ovarian cancer: a systematic review - anti-angiogenesis

List of trauma centers in the United States Adult Level I

ClinicalTrials.gov

癌症研究所－臺灣癌症臨床研究合作組織癌症臨床指引
婦女醫學資料庫 - 卵巢癌
European Society for Medical Oncology Guideline Gynaecologic Cancers

Peritoneal Cancer Index (PCI)
2007 Intraperitoneal chemotherapy in the first-line treatment of women with stage III epithelial ovarian cancer: a systematic review with metaanalyses.
2008 Why i.p. therapy cannot yet be considered as a standard of care for the first-line treatment of ovarian cancer: a systematic review.
2009 Advanced cancer of the ovary: intraperitoneal chemotherapy as a new therapeutical option.
2009 Pros and cons of intraperitoneal chemotherapy in the treatment of epithelial ovarian cancer.
2010 Intraperitoneal catheter leads to prolongation of the time to normalization of serum CA125 levels.
2012 CA125 regression in ovarian cancer patients treated with intravenous versus intraperitoneal platinum-based chemotherapy: a gynecologic oncology group study.
* 2011 Ovarian Cancer Diagnosis and Treatment

Postoperative nausea and vomiting NeiGuan Pericardium Meridian 6 accupressure, Zofran (5-HT3 antagonists)
Chyle - milky bodily fluid consisting of lymph and emulsified fats, or free fatty acids (FFAs). A chyle fistula is a leakage of lymphatic fluid from the lymphatic vessels, typically accumulating in the thoracic or abdominal cavities, possibly leading to a chylothorax or chylous ascites, respectively.

HemOnc.org - A Free Hematology/Oncology Reference

Dosage:
Body Surface Area calculator 100lb 61" = 1.4 m^2
AUC (area under curve) serum creatinine (0.5-1.0) AUC6 = 460mg

全民健康保險藥品給付規定
Drugs@FDA FDA Approved Drug Products

FDA Hematology/Oncology (Cancer) Approvals & Safety Notifications recently approved drugs

Approved Drugs, Drugs used in UK
cisplatin 1978, carboplatin 1989, taxol 1992, doxil 1995, topotecan 1996, gemzar 2006, bevacizumab 2014, olaparib 2014

*TAXOL (paclitaxel) *1992+cisplatin
西藥許可證衛署藥製字, 衛署藥輸字抗癌藥
PACLITAXEL Paclitaxel Shortage
太平洋紫杉醇 Taiwan price 175mg/m^2 * 1.4 = 245mg = $8000
corticosteroids, diphenhydramine, and H2 antagonists.
premedication: corticosteroids (steroid dexamethasone 20 mg [causing stomach upset and effects of dexamethasone on the proliferation and apoptosis]) PO administered approximately 12 and 6 hours before TAXOL, diphenhydramine-Benadryl (or its equivalent) 50 mg IV 30 to 60 minutes prior to TAXOL, and fast-acting acid reducer H2 antagonists (cimetidine-Tagamet 300 mg [Tagamet HB 200], ~~ranitidine-Zantac 50 mg [Zantac 150]~~, famotidine-Pepcid [Pepcid AC 20mg]) IV 30 to 60 minutes before TAXOL.
Neutropenia - 500 - 1000 - 1500, G-CSF - Filgrastim (Neupogen), Pegfilgrastim (Neulasta), Tbo-filgrastim (Neutroval)
Anemia - blood transfusion, Epoetin alfa (Epogen/Procrit), Darbepoetin alfa (Aranesp) - erythropoiesis-stimulating agents (ESA) are not for cure
Thrombocytopenia -
Peripheral neuropathy - Glutamin 10g*3/day, Pyridoxine (Vitamin B6 100mg) - might affect response and remission

aluminum hydroxide and magnesium hydroxide [Maalox], Bismuth subsalicylate [Pepto-Bismol]
fast-acting acid reducer H2 antagonists: cimetidine-Tagamet 300 mg [Tagamet HB 200], famotidine-Pepcid [Pepcid AC 20mg]

slow-acting Proton pump inhibitor (H2 antagonists) (Omeprazole [Prilosec OTC, Zegerid OTC])

European Human Medicines for Ovarian Neoplasms: Avastin (bevacizumab) and others

*ABRAXANE nab-paclitaxel protein-bound particles albumin-bound, 2005 breast, NSCLC

*TAXOTERE (docetaxel) breast, 1999 NSCLC, prostate, ..
歐洲紫杉醇 75mg/m^2 * 1.4 = 105mg = $21000

Cynviloq paclitaxel polymeric micelle in trial

*PARAPLATIN (carboplatin) *1989+cyclophosphamide
西藥許可證衛署藥製字, 衛署藥輸字卵巢癌
Carboplatin shortage
佳鉑帝 Taiwan price 460mg = $4000
allergic reactions - epinephrine (adrenaline), corticosteroid (dexamethasone), and antihistamine therapy: Benadryl (diphenhydramine)
Chemotherapy-induced nausea and vomiting (emesis) 24 hour premedication: antiemetics - 5-HT3 antagonists: Zofran (Ondansetron) 1991, Aloxi (Palonosetron delayed CINV 2-5 days) 2003; Dopamine antagonist Reglan metoclopramide (older)

*CISPLATIN *1978+cyclophosphamide [ETHYOL (amifostine) reducing renal toxicity]
西藥許可證衛署藥輸字轉移性睪丸腫瘤,轉移性卵巢腫瘤,膀胱內轉移型細胞腫瘤
順鉑 Taiwan price 75mg/m^2 * 1.4 = 105mg = $400
PLATINOL (cisplatin) Guidelines for Hospitalization for Chemotherapy outpatient 75mg/m^2
Mannitol
Emend (aprepitant) NK1 antagonists 2003 + 5-HT3 antagonists: Zofran (Aloxi) + Dexamethasone (steroid)
Epinephrine (adrenaline), corticosteroids, and antihistamines: Benadryl (diphenhydramine)

*Tamoxifen 2x20mg daily, increasing CA125

*relapsed at least 6 months after platinum-based treatment
GEMZAR (gemcitabine) *1996(non-small cell lung)-2006 (ovarian+carboplatin) last cytotoxic drug
西藥許可證衛署藥製字, 衛署藥輸字 1.非小細胞肺癌2.胰臟癌3.膀胱癌4.乳癌5.卵巢癌
健澤, 吉西他滨 1000mg/m^2 * 1.4 * 2 = 2800mg = $13000
GEMCITABINE *
1. with carboplatin, bevacizumab (ascites) dosage C AUC4, G 1000mg/m^2 D1,D8, BEV 15mg/kg D1, q21D x 6c -> BEV q21D, Trial, recurred 6 month after maintenance, during maintenance, HE4, CA125
2. with cisplatin, bevacizumab Gemcitabine in Ovarian Cancer C 75mg/m^2, G 1250mg/m^2 D1, D8, BEV 15mg/kg D1...

*after 3 chemo
Lynparza Olaparib *2014 PARP-inhibitor for germline BRCA mutated, best for platinum sensitive, not somatic cells
400mg*2 daily, Proton pump inhibitor (Pantoprazole) or H2 antagonists for dyspepsia, diarrhea, or nausea

*platinum-resistant, first or second relapse
Bevacizumab (Avastin) *2014 (with Taxol, Gemzar, PLD, Topotecan)
癌思停 15mg/kg/3weeks * 45kg = 675mg = $65000
Seeking Alpha: Roche's Avastin Should Get The Nod From The FDA On November 19

*after platinum
DOXIL (Liposomal Doxorubicin Hydrochloride) *1995 (also multiple myeloma)
微脂體小紅莓化療藥物合併鉑金藥物, 多柔比星脂质体
康利斯微脂粒 Caelyx 50mg/m^2 * 1.4 = 70mg = $43000
Doxil with Carboplatin - 30mg/m^2 + AUC 5 (4 weekly), escalated to AUC 6 and then 40mg
Maintenance 30–40 mg/m^2 given every 4–8 weeks, heart failure after cumulative 550mg/m^2
Early changes in CA125 after treatment with pegylated liposomal doxorubicin or topotecan do not always reflect best response in recurrent ovarian cancer patients
Human ovarian cancer stem/progenitor cells are stimulated by doxorubicin but inhibited by Mullerian inhibiting substance

*metastatic, failure of initial and subsequent chemotherapy
HYCAMTIN (topotecan) *1996 (also cervical, small cell lung cancer) Caris no
癌康定, 托泊替康 1.5mg/m^2 * 1.4 * 5 day = 10.5mg = $21500
with Bevacizumab schedule
1, topotecan 4mg/m^2 days 1, 8, 15 every 4 weeks + Avastin 10mg every 2 weeks
2. topotecan 1.25mg/m^2 days 1-5 every 3 weeks + Avastin 15mg every 3 weeks

Etoposide trial 1983 SCLC oral 50-60mg/m2/d for 21 days per 28 days
抑特癌 50*1.4*21 = 70m2*21 = $5000

Alkylating antineoplastic agent
*Cyclophosphamide Cytoxan *1959 (malignant disease)
癌德星
-Ifosfamide *1988
-Melphalan

*Altretamine *1990

Other 3rd line
Pemetrexed Caris no
Vinorelbine
Capecitabine Caris no

Pazopanib (Votrient) tyrosine kinase inhibitor, angiogenesis inhibitor VEGF-R 800mg daily, 2009 renal, sarcoma
福退癌 200mg*4 $677 = $56868 / 3 weeks maintenance
result not as good for East Asian Women, report, bad for Asian Women, Neutropenia, thrombocytopenia and palmar-plantar erythrodysaethesia syndrome were observed more frequently in patients of East Asian descent 亞洲

Nivolumab Opdivo anti-PD-1, 3 mg/kg IV every 2 weeks