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Peritonial Cancer Consultation Report - Online Cancer Consultation - Navya Care

Check the sample of expert treatment on Peritoneal Cancer provided by Navya. Navya Care provide cancer consultation online by checking patientu2019s case reports and give them expert opinion. To know more, visit https://navya.care/

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Peritonial Cancer Consultation Report - Online Cancer Consultation - Navya Care

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  1. Dear , Thank you for reaching out for an online cancer consultation service for assessing your treatment options. We converted your case reports into a structured summary to be reviewed by a nationally acclaimed medical oncologist in the Gynecology Disease Management Group and by an internationally renowned expert gynecologic oncologist, trained at M.D. Anderson Cancer Center, Houston. We assessed the following question(s) on your behalf: 1.Are additional diagnostic tests recommended at this time? 2.Is chemotherapy recommended at this time? If yes, then what is the recommended regimen? The TMC NCG Navya opinion is summarized as follows: 1.Germline testing for p53 is recommended at this time. 2.Additionally, mutational testing of the BRCA gene (i.e. mutation of BRCA1 or BRCA2 gene), is recommended at this time. 3.Chemotherapy is recommended at this time. 4.Treating oncologist(s) should assess fitness to receive chemotherapy and monitor organ function with Complete Blood Counts(CBC), Renal Function Test (RFT), Liver Function Test (LFT), electrolytes, and general condition/ performance status/ ECOG score (i.e., the extent of physical activity, ability to care for oneself, self care, and number of hours of rest). 5.If the treating oncologist(s) assess fitness to receive chemotherapy, then combination chemotherapy with Irinotecan 100 mg/m2 over 90 minutes intravenously on day 1, day 8, and day 15, every four weeks (i.e. in a 28 day cycle) and Bevacizumab 10 mg/kg every two weeks (i.e. in a 14 day cycle) until disease progression or dose limiting toxicity, is recommended at this time. 6.Alternatively, or if unfit to receive combination chemotherapy (as above), then single agent chemotherapy with Gemcitabine 1000 mg/m2 over 30 minute intravenous infusion on day 1, day 8 and day 15, every four weeks (i.e. in a 28 day cycle) may be considered. 7.Continuing symptomatic treatment (i.e. therapy that eases symptoms such as pain, discomfort, etc) and supportive care (i.e. treatment given to prevent, control, or relieve complications and side effects and to improve comfort and quality of This TMC NCG Online Expert Opinion Service, and Navya Network Inc., does not diagnose, treat, give orders, or have the ultimate Page 1 authority over the care of any individuals.

  2. life) during chemotherapy is recommended. 8.After completing every three cycles to four cycles of the recommended chemotherapy (either with Irinotecan and Bevacizumab or Gemcitabine), assessment of response (i.e. whether the tumor(s)/lesion(s) in the body have decreased/not increased/increased) with ultrasound/CT scans with oral and iv contrast of the chest/abdomen/pelvis or PET CT scan of the whole body is recommended. We hope that the cancer expert opinion is helpful in determining the course of your treatment. Please discuss this opinion with your treating oncologist(s). You may reach out to us for an expert opinion for further treatment plan with targeted therapy, recommendation for which will depend upon recent organ function tests/germline test/ BRCA test. If your treatment plan involves complex details such as a choice of immunotherapy vs targeted therapy or enrollment in a clinical trial or bone marrow transplant, etc., please write to us at reports@navya.care We will prioritize a response based on clinical urgency as it pertains to your receiving on time care. Questions on managing ongoing side effects of cancer treatments such as pain, mouth sores, fever, infection, bleeding, etc. are only suited for in person examination with your local treating oncologist(s)/physician(s). These questions are not amenable to an online expert review. Navya is focused on assessing your cancer treatment options. If you are a financially underprivileged patient or receiving treatment under the General Category of any hospital, please reach out to us after you complete your current therapies (surgery or chemotherapy or radiation, etc.) We will assess your treatment response and continue to provide your next treatment plans at no cost. Please do not hesitate to write to us or call us with any questions. Sincerely, Gitika Srivastava This TMC NCG Online Expert Opinion Service, and Navya Network Inc., does not diagnose, treat, give orders, or have the ultimate Page 2 authority over the care of any individuals.

  3. CASE SUMMARY Expert Opinion ID Current Diagnosis: Metastatic Peritoneal Cancer Age: 77 Years Old Gender: Female Hypertension (High BP): Yes Hypothyroid: Yes Hypercholesterolemia: Yes Diabetes: Yes Other Heart Problems: Coronary Heart Disease, Stent (2006) Chronic Kidney Disease: Yes (Early Proteinuria) History of Cancer: Yes Note: Diagnosed with APML in 2004. treated with Arsenic Trioxide followed by maintenance therapy with 6-MP, MTX & ATRA. Now in remission First Presentation: [2010] Complaint(s): Abdominal bloating & distension [2010] FDG- PET CT: Metabolic activity in omentum, peritoneum & pelvis; ascites. [2010] CA 125: 2793 [August 2010] Diagnosis Made By: Paracentesis [August 2010] Malignant Disease: Mullerian Adenocarcinoma (Peritoneal Primary) Cancer Grade: III This TMC NCG Online Expert Opinion Service, and Navya Network Inc., does not diagnose, treat, give orders, or have the ultimate Page 3 authority over the care of any individuals.

  4. Prior Surgery #1: Intent-Timing Therapy/Regimen Treatment Date Start Curative-Definitive Upfront - Primary Surgery Cytoreductive August 2010 Surgery Note: 8*8 cm omental tumor mass at hepatic flexure; 2*1.5 cm distal pancreatic tail involving omentum tumor; 3*3 cm terminal ileum tumor arising from serosa of terminal ileum & involving mesentery Malignant Disease: Papillary Serous Carcinoma Cancer Grade: III Note: ? Myometrium origin with extensive peritoneal met. No primary tubal or ovarian lesion Prior Chemotherapy #1: Intent-Timing Therapy/Regimen Treatment Start Date Treatment End Date Curative-Definitive Adjuvant - Ca.iv/P.iv: Ca.iv(6)/P.iv(175)_q21#6 September 2010 December 2010 Note: Patient was on regular follow up Second Presentation: [May 2012] FDG- PET CT: Recurrence. [2012] This TMC NCG Online Expert Opinion Service, and Navya Network Inc., does not diagnose, treat, give orders, or have the ultimate Page 4 authority over the care of any individuals.

  5. Prior Chemotherapy #2: Intent-Timing Therapy/Regimen Treatment Start Date Treatment End Date Curative-Salvage - 1st Line Ca.iv/P.iv: Carboplatin/Paclitaxel#5 2012 December 2012 Chemo SE: Bone Marrow Suppression FDG- PET CT: No recurrent or metastatic lesion. [February 2nd 2013] Note: Patient was on a regular follow up with PET CT scans between 2013 to 2018. Stable portocaval, porta hepatic LNs & slow progression seen in November 2017. Patient was not on active cancer treatment. Third Presentation: [January 2018] FDG- PET CT: Progression. [January 24th 2018] Note: PET Details not available. CA 125: 764 [February 2018] Diagnosis Made By: Biopsy- Ampulla [February 2018] Malignant Disease: Papillary Serous Carcinoma Prior Chemotherapy #3: Intent-Timing Therapy/Regimen Treatment Start Date Treatment End Date Palliative- Metastatic Carboplatin/ Liposomal Doxorubicin #3--> Carboplatin#2 February 2018 June 2018 Note: LipoDox stopped i/v/o toxicity Chemo SE: Myelosuppression This TMC NCG Online Expert Opinion Service, and Navya Network Inc., does not diagnose, treat, give orders, or have the ultimate Page 5 authority over the care of any individuals.

  6. CA 125: 12 [July 2018] FDG- PET CT: Interval reduction in abdominal LNs, liver lesions & mediastinal LNs. No recurrent lesion. No metastatic disease elsewhere. [August 18th 2018] Fourth Presentation: [December 2018] Complaint(s): Fever [December 2018] FDG- PET CT: Disease Progression. 1.7*1.4 cm segment III (SUV-5.3), 2.4*1.6 cm segment VII (SUV-4.6), 1.4*1.1 cm segment VI (SUV-4.2) liver lesion; 1.2*0.8 cm Rt level IV LN (SUV-2.6); b/l prevascular LNs- largest 1.4*1.1 cm Lt (SUV-3.2), b/l lower paratracheal LNs- 1.7*1.2 cm Rt (SUV-4.2), 1*0.8 cm Lt hilar LN (SUV-3.2). [December 1st 2018] Bone Marrow (Hematologic) Function: Not Available Kidney (Renal) Function:Not Available Liver (Hepatic) Function: Not Available Heart (Cardiac) Function: Not Available Functional Status- ECOG Score: 1 Resource Constraint: No General Condition: Patient is able to do daily activities, however is experiencing fevers almost every night, feels weak due to this. Note: Patient/caregiver understands the risk factor of age and complexity of an online opinion based on the above facts alone, yet desires the online opinion This TMC NCG Online Expert Opinion Service, and Navya Network Inc., does not diagnose, treat, give orders, or have the ultimate Page 6 authority over the care of any individuals.

  7. Navya is a Cambridge, MA based company with offices in Bangalore, India. Navya is founded by graduates of Harvard University, MIT Sloan School of Management, and the Stanford School of Medicine. Navya’s innovative and scalable decision making system is a technology powered solution for complex medical questions. Navya’s software solutions are efficient engines to gather and synthesize individual goals of care, evidence specific to an individual medical case, and expert opinion, for evaluating treatment alternatives. Navya’s goal is to assist in bringing clarity to the complexity of evaluating treatment alternatives. Navya’s system collects the best available information and expertise from several worldwide sources relevant to a specific previously diagnosed medical case and assesses treatment decisions. For more information, please visit www.navya.care or call +91 80-61787700 or email gitika@navya.care Navya Network, Inc does not diagnose, prescribe medication, treat, or give orders, nor does Navya have the ultimate authority over the care of any individuals. Navya does not provide medical advice nor does its products, services, systems, projects, or programs constitute the practice of medicine, nursing, or any other health care profession. Any information provided by Navya as a result of use of Navya’s products, services, systems, projects, or programs is being provided solely for educational and informational benefit and should not be considered diagnosis, treatment or a substitute for professional medical advice. Use of Navya’s products, services, systems, projects, or programs does not establish a doctor-patient relationship. Navya encourages that individuals or patients using Navya’s products, services, systems, projects, or programs share any reports or other information generated by the use of Navya’s products, services, systems, projects, or programs with their treating health care provider. Use of Navya’s products, services, systems, projects, or programs is voluntary and any information communicated as a result of the use of Navya’s products, services, systems, projects, or programs is not intended to be, nor implied to be, and cannot and should not be used as a substitute for professional medical advice, diagnosis or treatment. Navya’s products, services, systems, projects, or programs are limited to the provision of consultative services with respect to known or previously-identified condition and neither Navya, nor its employees, consultants or agents with whom it contracts will diagnose, treat, give orders, prescribe medications or have any authority over the care of any individuals. Navya’s products, services, systems, projects, or programs will not involve any direct face-to-face encounters or physical examinations. Accordingly, individuals using Navya’s products, services, systems, projects, or programs are encouraged to share and discuss any information provided as a result of use of Navya’s products, services, systems, projects, or programs with their treating physician. The individuals or patients using Navya’s products, services, systems, projects, or programs will be the ultimate decision maker over their own care. This TMC NCG Online Expert Opinion Service, and Navya Network Inc., does not diagnose, treat, give orders, or have the ultimate Page 7 authority over the care of any individuals.

  8. INDIVIDUALS OR PATIENTS USING NAVYA’S PRODUCTS, SERVICES, SYSTEMS, PROJECTS, OR PROGRAMS SHOULD NEVER DELAY OR AVOID SEEKING MEDICAL ADVICE OR ATTENTION FROM THEIR REGULAR HEALTH CARE PROVIDER OR TREATING PHYSICIAN OR DOCTOR BECAUSE OF SOMETHING THEY HAVE LEARNED THROUGH THEIR USE OF NAVYA’S PRODUCTS, SERVICES, SYSTEMS, PROJECTS, OR PROGRAMS. SHOULD ANY UNEXPECTED MEDICAL EVENT OCCUR WHILE AN INDIVIDUAL OR A PATIENT IS PARTICIPATING IN THE USE OF NAVYA’S PRODUCTS, SERVICES, SYSTEMS, PROJECTS, OR PROGRAMS, THE INDIVIDUAL OR THE PATIENT SHOULD IMMEDIATELY CALL THEIR HEALTHCARE PROVIDER OR TREATING PHYSICIAN OR DOCTOR OR LOCAL EMERGENCY ASSISTANCE NUMBER OR IMMEDIATELY VISIT THEIR LOCAL EMERGENCY ROOM. NAVYA AND ITS EMPLOYEES, CONSULTANTS, PARTNERS, AND EXPERTS ARE NOT AND SHALL NOT BE CONSTRUED AS BEING YOUR DOCTORS OR PHYSICIANS OR ONCOLOGISTS OR HEALTHCARE PROVIDERS FOR ANY PURPOSE WHATSOEVER. This TMC NCG Online Expert Opinion Service, and Navya Network Inc., does not diagnose, treat, give orders, or have the ultimate Page 8 authority over the care of any individuals.

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