Primary peritoneal cancer: Difference between revisions
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:* Preferred regimen (2): [Paclitaxel 135-175 mg/m2 IV infused over 3 hours {{and}} carboplatin AUC 5-7.5 IV infused over 30-60 min every 21 d for three to six cycles] {{or}} [Docetaxel 60-75 mg/m 2 IV infused over 1 h {{and}} carboplatin AUC 5-6 IV infused over 1 h every 21 d for three to six cycles] | :* Preferred regimen (2): [Paclitaxel 135-175 mg/m2 IV infused over 3 hours {{and}} carboplatin AUC 5-7.5 IV infused over 30-60 min every 21 d for three to six cycles] {{or}} [Docetaxel 60-75 mg/m 2 IV infused over 1 h {{and}} carboplatin AUC 5-6 IV infused over 1 h every 21 d for three to six cycles] | ||
====Treatment of Recurrent Disease==== | ====Treatment of Recurrent Disease==== | ||
====Platinum-sensitive disease==== | |||
:* Preferred regimen(1): Paclitaxel 135-175 mg/m 2 IV infused over 3 h plus carboplatin AUC 5-6 IV infused over 1 h every 21 d for six cycles | :* Preferred regimen(1): Paclitaxel 135-175 mg/m 2 IV infused over 3 h plus carboplatin AUC 5-6 IV infused over 1 h every 21 d for six cycles | ||
:* Preferred regimen(2): Docetaxel 60-75 mg/m 2 IV infused over 1 h plus carboplatin AUC 5 IV infused over 1 h every 21 d for three to six cycles | :* Preferred regimen(2): Docetaxel 60-75 mg/m 2 IV infused over 1 h plus carboplatin AUC 5 IV infused over 1 h every 21 d for three to six cycles | ||
| Line 151: | Line 152: | ||
:: Note: Bevacizumab (15 mg/kg every 3 wk) may be added to the regimen | :: Note: Bevacizumab (15 mg/kg every 3 wk) may be added to the regimen | ||
:* Preferred regimen(5): Carboplatin AUC 2 IV push with paclitaxel 80 mg/m 2 IV infused over 3 h on days 1, 8, and 15 | :* Preferred regimen(5): Carboplatin AUC 2 IV push with paclitaxel 80 mg/m 2 IV infused over 3 h on days 1, 8, and 15 | ||
====Platinum-resistant disease==== | |||
:* Preferred regimen(1): Pegylated liposomal doxorubicin 50 mg/m 2 IV infused over 30 min every 21 d | |||
:* Preferred regimen(2): Topotecan 1.25 mg/m 2 IV infused over 30 min on days 1-5 every 21 d | |||
:* Preferred regimen(3): Gemcitabine 1000 mg/m 2 IV infused over 30 min on days 1 and 8 every 21 d | |||
====Combination Regimen==== | |||
* Bevacizumab 10 mg/kg IV every 14 d in combination with one of the following IV chemotherapy regimens: paclitaxel, pegylated liposomal doxorubicin, or topotecan (topotecan is given weekly) | |||
* Bevacizumab 15 mg/kg IV every 21 d in combination with topotecan (every 21 d) | |||
==== Acute Pharmacotherapies ==== | ==== Acute Pharmacotherapies ==== | ||
Revision as of 18:51, 6 January 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Ammu Susheela, M.D. [2]
Overview
Historical Perspective
Classification
Pathophysiology
Primary peritoneal cancer is a cancer of the cells lining the peritoneum, or abdominal cavity.[1] Some studies indicate that between 7 and 20 percent of initially diagnosed epithelial ovarian cancers could be properly reclassified as primary peritoneal cancers. Primary peritoneal cancer or carcinoma is also known as serous surface papillary carcinoma, primary peritoneal carcinoma, extra-ovarian serous carcinoma, primary serous papillary carcinoma, psammomacarcinoma. It was historically classified under "carcinoma of unknown primary" (CUP). Primary peritoneal cancer (PPC, or PPCa)[2] is a cancer of the cells lining the peritoneum, or abdominal cavity. Histomorphological and molecular biological characteristics suggest that serous carcinomas, which include ovarian serous carcinoma, uterine serous carcinoma, Fallopian tube serous carcinoma, cervical serous carcinoma, and primary peritoneal serous carcinoma really represent one entity.[3]
Theory
Ovarian and peritoneal epithelium share common embryonal origin, the coelomic epithelium (mesodermal origin). Coelomic epithelium is thought to be of mesonephric origin. With the overall point being that normal ovarian and peritoneal tissue is derived from the mesonephros. On the contrary, fallopian tube epithelium, endometrium and endocervix are related to paramesonephros (Müllerian duct). Surprisingly, epithelial ovarian cancer and primary peritoneal cancer are histologically similar to the Mullerian epithelium; not their embryonal origin, the mesonephros. Either a metaplasia has occurred or Mullerian remnants have been left behind in coelemic epithelium, which have turned oncogenic.
Genetics
Genetic causes
Although the precise causes are not known, a link with certain variants of BRCA1/2 has been described.[4] Furthermore, women with BRCA1/2 mutation have a 5% risk of developing primary peritoneal cancer even after prophylactic oophorectomy.
Primary peritoneal carcinoma shows similar rates of tumor suppressor gene dysfunction (p53, BRCA, WT1) as ovarian cancer and can also show an increased expression of HER-2/neu.
An association with vascular endothelial growth factor has been observed.[5]
Associated Conditions
Gross Pathology
Microscopic Pathology
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Causes by Organ System
Differentiating Primary peritoneal cancer from other Diseases
The cancer does involve mesothelial cells and can be medically described as mesothelioma; however, this cancer should not be confused with asbestos-related mesothelioma, which requires different treatments and has a much higher mortality rate.
Epidemiology and Demographics
Age
Gender
- Females are more commonly affected with primary peritoneal cancer than males.
Race
Developed Countries
Developing Countries
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
If available, the diagnostic criteria are provided here.
History
A directed history should be obtained to ascertain
Symptoms
"Type symptom here" is pathognomonic of the "type disease name here".
"Type non specific symptoms" may be present.
Past Medical History
Family History
Social History
Occupational
Alcohol
The frequency and amount of alcohol consumption should be characterized.
Drug Use
Smoking
Allergies
Physical Examination
Appearance of the Patient
Vital Signs
Skin
Head
Eyes
Ear
Nose
Mouth
Throat
Heart
Lungs
Abdomen
Extremities
Neurologic
Genitals
Other
Laboratory Findings
Electrolyte and Biomarker Studies
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Prognosis and treatment is the same as for the most common type of ovarian cancer, which is epithelial ovarian cancer.[6][7]
The median survival of primary peritoneal carcinomas is usually shorter by 2–6 months time when compared with serous ovarian cancer. Studies show median survival varies between 11.3–17.8 months. One study reported 19-40 month median survival (95% CI) with a 5 year survival of 26.5%.[citation needed]
Elevated albumin levels have been associated with a more favorable prognosis.[8]
- Optimal tumor debulking followed by chemotherapy is the mode of treatment of primary peritoneal cancer.
Pharmacotherapy
- Preferred regimen[9](1): Paclitaxel 135 mg/m2 IV over 24 h on day 1 AND cisplatin 100 mg/m2 IP on day 2 AND paclitaxel 60 mg/m 2 IP on day 8 for 21 days for 6 cycles.
- Preferred regimen (2): [Paclitaxel 135-175 mg/m2 IV infused over 3 hours AND carboplatin AUC 5-7.5 IV infused over 30-60 min every 21 d for three to six cycles] OR [Docetaxel 60-75 mg/m 2 IV infused over 1 h AND carboplatin AUC 5-6 IV infused over 1 h every 21 d for three to six cycles]
Treatment of Recurrent Disease
Platinum-sensitive disease
- Preferred regimen(1): Paclitaxel 135-175 mg/m 2 IV infused over 3 h plus carboplatin AUC 5-6 IV infused over 1 h every 21 d for six cycles
- Preferred regimen(2): Docetaxel 60-75 mg/m 2 IV infused over 1 h plus carboplatin AUC 5 IV infused over 1 h every 21 d for three to six cycles
- Preferred regimen(3): Pegylated liposomal doxorubicin 30 mg/m 2 IV infused over 30 min plus carboplatin AUC 5 IV every 21 d for six cycles
- Preferred regimen(4): Gemcitabine 1000 mg/m 2 IV on days 1 and 8 plus carboplatin AUC 4 on day 1 every 21 d for six cycles
- Note: Bevacizumab (15 mg/kg every 3 wk) may be added to the regimen
- Preferred regimen(5): Carboplatin AUC 2 IV push with paclitaxel 80 mg/m 2 IV infused over 3 h on days 1, 8, and 15
Platinum-resistant disease
- Preferred regimen(1): Pegylated liposomal doxorubicin 50 mg/m 2 IV infused over 30 min every 21 d
- Preferred regimen(2): Topotecan 1.25 mg/m 2 IV infused over 30 min on days 1-5 every 21 d
- Preferred regimen(3): Gemcitabine 1000 mg/m 2 IV infused over 30 min on days 1 and 8 every 21 d
Combination Regimen
- Bevacizumab 10 mg/kg IV every 14 d in combination with one of the following IV chemotherapy regimens: paclitaxel, pegylated liposomal doxorubicin, or topotecan (topotecan is given weekly)
- Bevacizumab 15 mg/kg IV every 21 d in combination with topotecan (every 21 d)
Acute Pharmacotherapies
Chronic Pharmacotherapies
Surgery and Device Based Therapy
Indications for Surgery
Pre-Operative Assessment
Post-Operative Management
Transplantation
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
References
- ↑ Primary peritoneal cancer. Wikipedia (2015). https://en.wikipedia.org/wiki/Primary_peritoneal_carcinoma Accessed on January 5, 2016
- ↑ Jaaback KS, Ludeman L, Clayton NL, Hirschowitz L (2006). "Primary peritoneal carcinoma in a UK cancer center: comparison with advanced ovarian carcinoma over a 5-year period". Int. J. Gynecol. Cancer. 16 Suppl 1: 123–8. doi:10.1111/j.1525-1438.2006.00474.x. PMID 16515579.
- ↑ Dubeau, L. (Dec 2008). "The cell of origin of ovarian epithelial tumours". Lancet Oncol. 9 (12): 1191–7. doi:10.1016/S1470-2045(08)70308-5. PMID 19038766.
- ↑ "Gynecologic Cancer Treatment — Primary Peritoneal Cancer — Dana-Farber Cancer Institute".
- ↑ Burger RA, Sill MW, Monk BJ, Greer BE, Sorosky JI (November 2007). "Phase II trial of bevacizumab in persistent or recurrent epithelial ovarian cancer or primary peritoneal cancer: a Gynecologic Oncology Group Study". J. Clin. Oncol. 25 (33): 5165–71. doi:10.1200/JCO.2007.11.5345. PMID 18024863.
- ↑ "New Drug Combination for Ovarian and Primary Peritoneal Cancers - National Cancer Institute".
- ↑ "eMedicine — Peritoneal Cancer : Article by Wissam Bleibel".
- ↑ Alphs HH, Zahurak ML, Bristow RE, Díaz-Montes TP (December 2006). "Predictors of surgical outcome and survival among elderly women diagnosed with ovarian and primary peritoneal cancer". Gynecol. Oncol. 103 (3): 1048–53. doi:10.1016/j.ygyno.2006.06.019. PMID 16876237.
- ↑ Foote EA, Postier RG, Greenfield RA, Bronze MS (2005). "Infectious Aortitis". Curr Treat Options Cardiovasc Med. 7 (2): 89–97. PMID 15935117.