Gynecologic Cancers

The patient was initially treated with Carboplatin/Paclitaxel and progressed after 1 year. She was switched to pembrolizumab and had significant progr...

1 Answer available

Do you recommend progesterone for endometrial protection in a young woman on estrogen replacement therapy for iatrogenic menopause after definitive radiation therapy for locally advanced cervical cancer?

If so, what do you typically prescribe?

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What do you view as the future role for the combination of durvalumab + olaparib + chemotherapy in the management of patients with advanced/recurrent endometrial cancer following the DUO-E trial results?

Are there certain patient subgroups for whom you would use the IO+PARPi? Is there data from DUO-E regarding BRCA status and its potential impact on ...

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In light of the improved outcomes seen in patients receiving IO +/- olaparib, what role, if any, do you think pelvic radiation still plays in the management of patients with advanced endometrial cancer?

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Would you consider offering immunotherapy +/- olaparib to a patient with early-stage endometrial carcinoma for whom you are recommending adjuvant chemotherapy based on improved outcomes seen in RUBY/DUO-E/NRG-GY018?

If yes, would you apply this broadly or reserve the addition of IO to chemotherapy for patients with high-risk histologies (e.g., carcinosarcoma) or o...

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In a patient with HER2+ advanced endometrial cancer, do you include IO(+/- olaparib) in their treatment regimen, or only trastuzumab in addition to carboplatin/paclitaxel?

Does your decision depend on MMR status? Would you use the same approach for neoadjuvant treatment?In light of relevant trials including RUBY, GY018, ...

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Would you recommend adjuvant chemo+IO +/- olaparib for patients with occult stage III disease identified after staging surgery with no measurable residual disease?

DUO-E, GY-018, and RUBY included patients with stage III and IV endometrial cancer WITH measurable disease.Would your decision change based on the mis...

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For patients with advanced endometrial cancer, are the improved outcomes in PFS from DUO-E/RUBY/NRG-GY018 sufficient to move immunotherapy to the frontline for all presuming FDA approval?

Are there patients for whom you would still reserve IO for salvage/recurrent setting (eg IO + lenvatinib)? Would you base this on MMR status or other ...

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How do you approach and manage anorexia and appetite loss in people with advanced cancer?

How do you counsel patients and caregivers? Do you prescribe medications (''appetite stimulants'') with the goal to improve appetite even if they do n...

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Do you follow GOG, ASTRO, or PORTEC recommendations for adjuvant therapy in stage I endometrial cancer patients?

What would you recommend for a patient in their 60s with stage IB grade 1 endometrial cancer without LVSI? How would this differ for a patient with st...

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Despite the paucity of strong data showing benefit of chemotherapy + radiotherapy in patients with stage I-II high risk histology endometrial cancer, if you recommend treatment with both modalities, how do you determine treatment schedule?

Do you proceed with sequential, concurrent, or sandwich treatment?

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What are your top takeaways from SGO 2023?

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Would you recommend PARP inhibitor maintenance for a patient with HR-proficient ovarian cancer with no targetable mutation, but with a favorable KELIM score and a significant clinical, radiographic, and serological response to platinum-based chemotherapy?

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After seeing results from GOG238, is there a subset of patients that might still benefit from chemoradiation for centrally recurrent endometrial cancer?

For example, do you think young patients might potentially benefit from the addition of cisplatin, knowing the average age in this study was 65.

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Would you treat endometrioid adenocarcinoma arising from an endometriosis lesion in a patient with prior hyst/BSO like an ovarian or endometrial primary?

Example: in a patient with a non-resectable pelvic mass involving the vagina but without evidence of distant disease, would you favor pelvic RT (as on...

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What is your approach to cancer patients who inquire about alternative or complementary treatments?

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Will you be changing your management of locally advanced cervical cancer based on the results of the INTERLACE trial presented at ESMO 2023?

The trial showed an overall survival benefit of 8% at 5 years with induction chemotherapy (80% vs 72%) utilizing at least 5 cycles of carboplatin-pacl...

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What is your strategy for breakthrough chemotherapy induced N&V in patients receiving highly emetogenic chemotherapy and already received a NK-1 antagonist, 5-HT3 antagonist, dexamethasone, and olanzapine?

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How do you manage a patient with cervical cancer who has FDG uptake in bilateral ischial tuberosities with lytic areas on CT correlate, and also has a history suspicious for untreated polymyalgia rheumatica with chronic symptoms in the same anatomic locations?

Cervical cancer FIGO stage IIIC2. Bloodwork shows elevated ESR and CRP.

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When do you expect the 2023 FIGO staging for endometrial cancer to become adopted clinically in the US?

How will you translate treatment recommendations from older studies to the new staging system?

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How do you counsel patients with locally advanced malignancies who have ECOG 3-4?

How do you advise patients who strongly desire chemotherapy?

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In patients with advanced endometrial cancer who you plan to treat with chemotherapy + immunotherapy (per GY018 or RUBY), how and when do you utilize adjuvant EBRT and/or brachytherapy?

Does the presence of parametrial or cervical involvement impact your decision? How do you sequence treatment modalities?

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How would you manage a Stage IB endometrioid endometrial cancer, status post staging surgery, with a rapid vaginal recurrence <1 month post operatively?

This case involves an impressive ‘high volume’ vaginal recurrence and patient was not originally planned for adjuvant therapy. Concerned t...

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When the initial diagnosis of stage I uterine leiomyosarcoma is made via a non-intact resection such as a myomectomy or supracervical hysterectomy, what factors, if any, might push you to consider adjuvant chemotherapy after completion surgery?

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When treating stage IVB cervical cancer with both systemic chemotherapy and local pelvic radiation therapy, do you incorporate the use of bevacizumab as in GOG 240?

Consider treatment of stage IVB cervical cancer with systemic therapy and local pelvic radiation therapy as in Perkins et al., PMID 31810653.

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In the absence of a cohesive workflow guiding the use of PARPi in ovarian cancer since the 2022 FDA approval withdrawals, what is your general approach to PARPi usage in the front-line and recurrent setting?

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How do you treat cervical cancer with an ovarian metastasis?

Considering this is stage IV disease, do your recommendations for definitive or adjuvant treatment (after surgery) change?

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Based on the data from GY018 and RUBY, do you offer immunotherapy in addition to carboplatin/paclitaxel first line to all patients with advanced endometrial cancer who qualify or only to those whose tumors are MMR protein deficient?

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Would you recommend adjuvant chemotherapy to a patient who has stage IB grade 1 endometrioid endometrial cancer with isolated tumor cells in two pelvic lymph nodes and extensive LVSI?

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Is there still a role of brachytherapy in uterine cancer if intensity-modulated radiation therapy is available?

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Is it safe to treat checkpoint inhibitor-induced arthritis with methotrexate or biologics?

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How should molecular studies, in particular the presence of POLE or p53 mutations, be incorporated into the decision to treat an "intermediate risk" endometrial cancer patient with adjuvant therapy after hysterectomy?

Considering the ASTRO guidelines recommend against systemic therapy for patients with FIGO stage I-II endometrioid adenocarcinoma, would your recommen...

6 Answers available

Why do we use dexamethasone for CNS edema and prednisone for pneumonitis?

Is this an artifact of what agent prior clinical trials used or something to do with the mechanism of action (i.e., less mineralocorticoid effect of d...

1 Answer available

What is the optimal approach for a younger female with borderline resectable cervix cancer who may need adjuvant radiation, in light of a medical history significant for ulcerative colitis?

MRI pelvis shows a 3.5 cm primary that appears infiltrative and without clear parametrial extension on MRI. Staging PET negative. Is there any ...

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What are your top takeaways in Gynecologic Cancers from ASCO 2023?

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How long would you continue second line maintenance PARP inhibitor in a patient with recurrent stage IV BRCA+ ovarian cancer who had CR and remains NED?

Do you extrapolate from first line maintenance studies for duration of therapy?

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With immunotherapy now often being used in the first-line setting for advanced endometrial cancer, what is the role of immunotherapy in the second-line?

Does the patient's MMR status affect your opinions? What is/are your current preferred second-line regimen(s)?

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Given patients with substantial LVSI experience a pelvic recurrence rate of ~25%, how do you counsel patients with stage IA endometrioid endometrial cancer with LVSI regarding the relative risks/benefits of EBRT versus VBT alone?

Please comment on toxicity profiles and the insufficient evidence regarding overall survival.

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For patients on immune checkpoint inhibitors presenting with chest pain, dyspnea, fatigue, and troponin elevation, would you recommend early initiation of high dose steroids for empiric treatment of ICI myocarditis while pursuing workup with coronary angiogram, echocardiogram, and/or cardiac MRI, or wait until alternative etiologies have been ruled out?

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Do you offer PARP inhibitor maintenance retreatment of platinum-sensitive, relapsed, high grade serous ovarian cancer in patients who had a complete response to their most recent platinum-based chemo?

Front-line PARP inhibitor maintenance therapy discontinued without progression.

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How should PARP inhibitors be incorporated into clinical practice in later line/maintenance of platinum-sensitive ovarian cancer for PARP inhibitor-naïve patients?

Considering updated trials, such as final OS data from NOVA, and recent society guideline updates?

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What outcome data do you view as most impactful to make treatment decisions regarding the use of PARP inhibitors in later line or recurrent ovarian cancer?

Given the crossover that occurred in the various clinical trials and the potential for prolonged disease duration, how do you integrate OS, PFS, treat...

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Given more restrictions on later line PARP inhibitor use for patients by BRCA status, would you consider repeat biopsy with somatic testing to identify candidates for second line maintenance therapy following platinum treatment for a patient who is gBRCAwt?

Does your approach change depending on the patients initial somatic BRCA status?

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What are best practices for oncologists during the national platinum shortage?

Please specify how your institution is allocating resources now or will be soon.

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What is your surveillance approach for outpatient monitoring of ICI myocarditis?

(i.e. frequency of serial BNP, troponin, cMRI)

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Given recent studies investigating ICI myocarditis biomarkers such as Temra CD8+ cells, is there now a growing selection of clinical biomarkers, besides BNP and troponin, being measured routinely in ICI myocarditis cases?

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When would you consider tapering glucocorticoids in a patient with ICI-associated myocarditis?

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What is your preferred first line systemic treatment for recurrent, metastatic, low grade, ER/PR+ pMMR endometrioid endometrial carcinoma?

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Would you consider chemoradiation + chemotherapy as in PORTEC-3 regimen for p53 mutated stage IA endometrial cancer, though this trial did not include those with stage IA disease?

If you do not use the PORTEC-3 regimen for p53 mutated IA endometrial cancer, what specific protocol or combination of chemotherapy and radiation ther...

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What is your approach to the adjuvant treatment of early-stage mixed-histology endometrial cancer with a significant clear-cell component?

How do you take into account pathologic factors like %clear cell histology, myometrial invasion, and LVSI?

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What is your response to the question, "Is this terminal?"

How do you "have the talk" in a way that is straightforward without emotionally crushing the patient?

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How do you approach adjuvant treatment for node positive high grade gastric type endocervical adenocarcinoma following radical hysterectomy?

When would you use 5-fluorouracil instead of, or in addition to, cisplatin during chemoradiation?

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What is your approach for treating locally-advanced gastric-type adenocarcinoma of the cervix?

When would you use 5-fluorouracil instead of, or in addition to, cisplatin during chemoradiation? When, if ever, would you offer adjuvant hysterectomy...

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If blood counts are being checked during concurrent chemoradiation, is there a number at which point you would recommend a radiation treatment break?

For example, concerning throbocytopenia or neutropenia during anal cancer treatment with concurrent mitomycin/5FU, or other pelvic malignancies treate...

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When, if ever, would you consider deep venous thrombosis prophylaxis for patients with advanced epithelial ovarian cancer undergoing neoadjuvant chemotherapy?

In your practice, what is the proportion of patients receiving neoadjuvant chemotherapy who are diagnosed with VTE? Does this differ from patients rec...

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How would you treat a recurrent endometrial cancer at the vaginal cuff that was initially FIGO 1A with no adj treatment, in a patient with actively treated scleroderma?

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How would you approach the adjuvant treatment of a stage IVA adenosarcoma of the ovary?

Would your systemic therapy choice be more similar to treatment of ovarian carcinoma or soft tissue sarcoma?

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What is your approach to the adjuvant treatment for stage IA grade 2 endometrioid adenocarcinoma without LVSI whose molecular classification is p53 abnormal (MMR intact, POLE wild type)?

How does your approach differ for patients under age 60, between 60-70, and over age 70?

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What is your treatment approach for a pediatric patient with uterine embryonal rhabdomyosarcoma found after removal of a prolapsing uterine mass, with no evidence of distant metastasis on imaging?

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How would you treat an isolated para-aortic lymph node endometrial cancer recurrence following a prolonged disease free interval previously treated with surgery, chemotherapy, and radiation therapy, if it is located outside of the previously irradiated field?

How does histology and/or molecular testing change your approach? How does the length of the disease free interval change your approach?

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How do you approach hormone replacement therapy for premenopausal patients following pelvic radiation therapy?

How is your approach different from or similar to those who undergo surgical menopause?

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How do you approach treatment for ovarian carcinosarcoma that has progressed during adjuvant carboplatin, paclitaxel, and bevacizumab following optimal tumor reductive surgery?

How would you approach the treatment if the tumor is PDL1+?

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What is your approach to first line systemic treatment for low risk gestational trophoblastic neoplasia?

Is there an optimal chemotherapy regimen that optimizes cure rates while minimizing side effects?

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Would you give checkpoint inhibitor therapy to a cancer patient with known dermatomyositis given the association of checkpoint inhibitor associated myocarditis, myasthenia gravis, and myositis?

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What is your approach to first line systemic therapy in metastatic PD-L1 positive cervical cancer?

Do you include pembrolizumab with platinum-taxane + bevacizumab or reserve it as a second line option?

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How would you approach the primary treatment of a rapidly growing uterine carcinosarcoma with local extension through the anterior abdominal wall?

If considering systemic therapy, would you consider standard chemotherapy or use biomarker-directed therapy (e.g., imatinib if ckit+, larotrectinib/en...

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How do you approach adjuvant therapy for patients with advanced ovarian cancer who undergo interval debulking surgery following six cycles of neoadjuvant chemotherapy?

How does your approach vary based on residual disease left at the time of surgery? Please specify your approach for the amount of residual disease at ...

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Do you initiate management of new onset diabetes in a patient on immunotherapy or refer immediately to endocrinology given the risk of rapid worsening?

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How do you discern whether elevated liver enzymes are from immunotherapy versus chemotherapy when a patient is on combination chemo/immunotherapy?

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How does your approach to low-risk gestational trophoblastic neoplasia differ for patients whose hCG levels plateau following initial single agent systemic therapy vs those who have a good initial response and then plateau?

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How do you approach systemic treatment for endometrial endometrioid adenocarcinoma with neuroendocrine differentiation?

In what situations would you use a neuroendocrine chemotherapy regimen over carboplatin+paclitaxel?

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What is your approach to adjuvant treatment for stage IA small cell carcinoma of the ovary, hypercalcemic type, after fertility sparing surgical staging?

1 Answer available

How do you manage steroid-refractory immune checkpoint inhibitor induced pneumonitis?

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Do you offer patients with advanced endometrial cancer lower starting doses of lenvatinib when used in combination with pembrolizumab given high adverse event rates with 20 mg daily?

Is there a role for using pembrolizumab alone in microsatellite stable endometrial cancer if patients are unable to tolerate lenvatinib?

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What are real world exclusion criteria for the use of lenvatinib + pembrolizumab for advanced endometrial cancer?

Are there specific clinical or social scenarios that would preclude the use of this treatment?

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Is there a difference in survival or disease response between patients with recurrence free interval ≥1 vs <1 year from platinum-based cytotoxic therapy who are treated with pembrolizumab + lenvatinib?

In the KEYNOTE-775 study, what was the proportion of patients who had a recurrence free interval ≥1 year from platinum-based cytotoxic chemotherapy...

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Are there any data that suggest superiority of lenvatinib + pembrolizumab vs platinum-based cytotoxic chemotherapy for advanced or recurrent endometrial cancer?

Are there any planned trials to compare lenvatinib + pembrolizumab and platinum-based cytotoxic chemotherapy for advanced or recurrent endometrial can...

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How do you approach adjuvant chemotherapy for high risk/advanced endometrial cancer patients?

Does your approach to the number of cycles vary based on plan to include radiation therapy or presence of certain histopathologic features?

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Is there a difference in the incidence of serious immune-related adverse events with the lenvatinib + pembrolizumab combination vs pembrolizumab alone in endometrial cancer?

Anecdotally, I have seen more serious IRAEs in patients I'm treating with this regimen than anticipated. Is there higher risk with this drug combinati...

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Can you continue checkpoint inhibitor therapy in the setting of severe cutaneous irAE while concurrently treating the cutaneous reaction?

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How would you manage a bulky, locally advanced endometrial cancer with extensive parametrial involvement in a patient inoperable due to medical comorbidities?

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When, if ever, would you consider lenvatinib + pembrolizumab as first line therapy for patients with stage IV microsatellite stable endometrial cancer?

Are there certain patient or disease related factors that would lead you to incorporate lenvatinib + pembrolizumab earlier?

1 Answer available

Do you routinely use mannitol to prevent cisplatin-induced nephrotoxicity?

If so, do you use it for all patients or only cisplatin doses >= 70 mg/m2? What dose of mannitol do you use?

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What is optimal therapy for a 5 year delayed recurrence of uterine cancer, rendered NED by solitary pulmonary metastasis resection?

And if the tumor is MSI-H, does that alter your thoughts?

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What is your institutional approach to a restrictive “neutropenic diet”?

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What is your strategy to help prevent paclitaxel-related neuropathy?

Do you prophylactically start all patients on B12, B-complex, and/or omega-3? If so, what dose? What about ice mittens and booties?

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Would you consider a PARP inhibitor in the treatment of a PARP inhibitor naïve platinum resistant recurrent ovarian cancer with LOH/HRD?

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In the setting of platinum resistant ovarian cancer, do you consider repeat use of bevacizumab with subsequent lines of chemotherapy following prior treatment with chemotherapy + bevacizumab with bevacizumab maintenance?

Considering the treatment of platinum resistant ovarian cancer as done in the AURELIA trial (Pujade-Lauraine et al., PMID 24637997).

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What are your top takeaways in Gynecologic Cancers from ASCO 2022?

What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice? ...

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What is your preferred adjuvant chemotherapy regimen after a completely resected stage IIIB Granulosa Cell tumor of the ovary?

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Do you routinely check tumor genomics, including POLE status for new endometrial cancers?

How does the presence of specific mutations affect your adjuvant treatment planning or patient counseling? Given POLE mutation status can currently o...

1 Answer available

How has the virtual aspect of tumor boards impacted their educational quality in the Covid-19 era?

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If a patient with HER2+ uterine serous carcinoma recurs while on maintenance trastuzumab, would you continue trastuzumab with second line chemotherapy?

Given data from metastatic breast cancer trials that show benefit with continuing trastuzumab despite progression.

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How do you manage insomnia in cancer patients that is refractory to traditional sleep aides?

In patients who continue to have insomnia despite diphenhydramine, benzos, and trazodone, are there other evidence based treatments that are helpful?

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How do you proceed after a patient has a partial response following 6 cycles of cisplatin + paclitaxel + bevacizumab +/- pembrolizumab for metastatic SCC of the cervix?

Assuming minimal toxicities except fatigue from long, recurrent infusions.

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How do you manage real-time release of pathology and radiology results to oncology patients following enaction of the CURES act?

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How do you determine duration of anticoagulation for an ovarian vein thrombosis following a provoking event?

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Would you modify standard WPRT+brachy radiation for cervical SCC s/p negative nodal staging but aborted hysterectomy due to previously undetected superficial vaginal disease?

1 Answer available

How do you manage patients with chemotherapy-induced paronychia?

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In patients with recurrent MSI-H endometrial cancer on immunotherapy with pembrolizumab, when do you discontinue therapy?

Do you stop therapy at 2 years or continue until progression of disease?

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What are your top takeaways from SGO 2022?

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Are there best practices or data regarding the use of open notes among oncology patients?

What is the impact among patients and providers? Has your documentation been adjusted now that patients can readily review?

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What is your adjuvant therapy for node positive, low grade endometrioid endometrial adenocarcinoma?

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How do you integrate ophthalmic exam and surveillance into routine visits for cervical cancer patients receiving tisotumab vedotin?

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Do you treat an endometrial cancer that is microsatellite-stable but has a high TMB after progressing on platinum-based therapy with pembrolizumab?

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What features help distinguish thyroid myopathy from immune checkpoint inhibitor-associated myopathy?

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How do you manage the wide array of emotions like anger and disappointment patients may have when they first learn of an incurable relapse of an early stage cancer?

How do you maintain a trusting relationship with your patients when this relapse occurs?

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What chemotherapy would you consider to treat platinum resistant high grade serous ovarian cancer in patients with a low grade MDS from prior platinum/PARPi?

Assuming low risk of progression to AML and eligible for low-risk chemotherapies per hematologic/oncology.

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When a patient with a preexisting rheumatic disease and on immunotherapy begins to flare, how do you decide if this is an underlying rheumatic disease activity versus an immunotherapy related adverse event?

How do you decide if it may be safe to continue immunotherapy?

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How do you manage a screening pap smear result of HSIL and HPV16+ in a first trimester pregnancy?

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Does the presence of an ATM mutation in advanced stage ovarian cancer influence the decision to use Bev vs PARP inhibitor for maintenance?

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What adjuvant therapy do you recommend for early stage poorly differentiated small cell neuroendocrine carcinoma of the cervix after surgical resection?

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When do you transfuse cervical cancer patients undergoing chemoradiation?

Do you try to keep Hb> 10 or 12? Or somewhere in between?

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What recommendations are you giving when patients ask about the best 'cancer diet' to be on?

Do you routinely recommend any dietary changes or is the evidence not convincing?

1 Answer available

When, if ever, would you recommend risk reducing BSO in patients with moderate penetrance breast cancer germline mutations?

Genes such as ATM, CHEK2, PALB2, RAD51C/D, BRIP1 seem to show some potential increased risk of ovarian cancer. Should these patients under prophylacti...

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How do you counsel premenopausal women with BRCA1 or BRCA2 mutations on the need for bilateral oopherectomy?

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Would concurrent endocrine therapy and PARPi maintenance be safe and appropriate after surgical treatment/adjuvant chemotherapy for a patient with BRCA1 mutated synchronous early stage HR+ breast CA and Stage IIA Fallopian tube carcinoma?

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What is your approach to the management of hot flashes in a patient who wants to use herbal medicine?

Do you allow patients with breast cancer on tamoxifen to use black cohosh?

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Would you add a PARP inhibitor to bevacizumab maintenance for a patient with a high grade serous ovarian cancer with a germline BRCA2 variant of unknown significance and negative somatic testing?

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In which patients with oncologic or hematologic disorders are you recommending a 3rd dose of mRNA COVID vaccine?

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In women of childbearing age with NMDA encephalitis and normal pelvic imaging, is there a role for oophorectomy for possible microteratoma?

If not, how often do you repeat pelvic imaging?

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Do you recommend adjuvant treatment for nodal isolated tumor cells in an otherwise low-risk endometrial cancer?

1 Answer available

How would you approach a primary small cell carcinoma of the vagina in a patient with an intact uterus and cervix?

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How would you proceed for a patient with metastatic gastric-type adenocarcinoma, with vaginal and inguinofemoral disease only, who experiences complete response to her vaginal tumor but residual inguinal disease?

History of CDH1 mutation and prophylactic gastrectomy in 2017 - no other primary site found beyond vagina at diagnosis. Vaginal tumor completely resp...

2 Answers available

What strategies have you found to be most effective in engaging PCPs in a primary-care or shared-care model of survivorship for pediatric and AYA patients who will receive ongoing care in their communities away from their primary oncology treatment site?

In follow up to @Jacqueline Casillas presentation at ASCO 2021 regarding models of survivorship care delivery for AYA patients.

1 Answer available

What is your approach to immunotherapy-related pancreatitis?

How do you manage the initial event, including length of steroid taper and the role of pancreatic enzyme monitoring? What is your experience of subse...

1 Answer available

In what scenario would you give consolidation chemotherapy after chemoradiation for stage 3 cervical cancer with a good response?

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Would you offer any adjuvant therapy for cervical cancer following total pelvic exenteration in the setting of a positive pelvic lymph node?

Previously received pelvic EBRT and intracavitary brachytherapy. IORT was administered to the node-positive side wall at the time of exenteration.

3 Answers available

How would you proceed after complete response to carboplatin/paclitaxel/bevacizumab in a patient who presented with distantly recurrent SCC of the cervix?

Initially treated with definitive chemoRT but recurred with distant mets. Completed 6 cycles carb/tax/bev with minimal toxicity. Excellent performance...

1 Answer available

What chemotherapy would you utilize for a metastatic dysgerminoma diagnosed in the second trimester of pregnancy?

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How would you manage a patient with history of locally advanced SCC of the cervix, treated with definitive chemoRT, found to have new lung lesions 6 months post treatment?

Lung is biopsy proven met cervix, SBRT is planned.

2 Answers available

What would be your treatment approach for a patient with a new PET positive para-aortic node 3 months following completion of definitive chemoradiation for locally advanced cervical cancer?

Patient did not previously receive para-aortic radiation. Considering RT vs RT + chemo vs chemo alone

1 Answer available

How do you manage cancer treatment-related cognitive change or "chemo brain?"

Are there any effective non-pharm or pharm interventions?

1 Answer available

How would you approach treatment for centrally recurrent cervical SCC with positive margins after excision that was not exenteration?

Recurrence was 2cm and PET confirmed local. Excision with positive margins. Current plan for salvage whole pelvic RT and vaginal cuff brachytherapy +/...

3 Answers available

How would you treat an advanced stage small-cell carcinoma of the ovary, hypercalcemic type? (SCCOHT)?

s/p optimal debulking. If this was an early-stage cancer would it change your adjuvant therapy recommendations?

1 Answer available

How would you adjust therapy for a patient with high risk, stage III choriocarcinoma (lung mets) in the context of renal insufficiency (Cr 3.8)?

1 Answer available

What chemotherapy regimen would you utilize for a metastatic, poorly differentiated carcinoma of the cervix with neuroendocrine features?

If confirmed neuroendocrine and PD-L1 pending, how would you treat?

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How would you manage a patient with history of stage IIIC HGSOC after secondary cytoreduction of isolated inguinal node recurrence 12 years after primary treatment?

Recurrence picked up incidentally on CT. No germ line mutations, somatic tumor testing of node resulted negative. PET confirmed isolated recurrence

1 Answer available

What is your strategy to prevent and treat constipation in patients initiating or receiving opioids?

What non-pharmacological interventions do you recommend? Do you routinely prescribe prophylactic laxatives to patients initiating opioids? How do you ...

3 Answers available

Would you recommend PARP inhibitor maintenance for a BRCA wild-type, HRD+ advanced ovarian cancer?

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After an optimal tertiary cytoreduction for recurrent granulosa cell tumor previously treated with BEP and hormonal therapy, would you recommend systemic chemotherapy?

Initial diagnosis was 15+ years ago

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Is there any role for PARPi maintenance in BRCA-/HRD- patients after response to front line chemotherapy +/- bevacizumab?

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What factors impact your decision to include bevacizumab with primary chemotherapy for patients with BRCA+ or HRD+ ovarian cancer?

Does your practice vary based on risk status (low vs high risk) or specific mutation status (BRCA+ vs HRD+) given PAOLA subset analyses?

4 Answers available

Are there circumstances where you would recommend every 6 week dosing schedule for pembrolizumab monotherapy?

I am considering every 6 week pembrolizumab dosing in patients >70 years old in whom I want to reduce clinic visits for, especially in the context ...

3 Answers available

What is your current practice for obtaining mutation status for a patient with newly diagnosed ovarian cancer?

What specific platforms for determining somatic BRCA and HRD status do you use for a patient who does not carry a germline BRCA mutation?

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How would you treat/counsel a patient with Stage IB3 SCC of the cervix who is 18 weeks pregnant and desires to maintain pregnancy?

1 Answer available

Is there a role for reassessing somatic mutation status at relapse in patients with epithelial ovarian cancer?

If yes, what type of testing platform would you use?

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When would you continue bevacizumab versus using PARPi alone for maintenance therapy in BRCA+ or HRD+ ovarian cancer after response to primary platinum + bevacizumab?

Are there clinical factors which help stratify? Does your practice vary based on mutation status (BRCA+ vs HRD+?)

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Which PARP inhibitor do you recommend for maintenance therapy in BRCA+ ovarian cancer after primary chemotherapy and why?

How do the 5 year results of SOLO-1 at ESMO 2020 impact your recommendations?

3 Answers available

How do you logistically give sandwich chemotherapy and whole pelvis radiation treatment in advanced endometrial cancer?

How many cycles do you prefer before and after? How long do you tend to wait before starting radiation after initial chemo and after radiation to resu...

1 Answer available

How do you advise patients on duration of first line maintenance PARPi and the potential risk of MDS or AML?

Is MDS/AML risk increased with longer duration of therapy? Does your approach differ for patients who are BRCA+/HRD vs wild type/HRP?

2 Answers available

What are the current official guidelines regarding COVID-19 vaccination for patients with cancer or for hematologic conditions?

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When might you recommend adjuvant chemotherapy for fully staged/resected stage IA clear cell ovarian carcinoma?

2 Answers available

How would you treat metastatic squamous cell carcinoma arising from a mature cystic ovarian teratoma?

1 Answer available

How do you counsel patients who are candidates for a clinical trial regarding their options?

Specifically, are there strategies you use to 1) empower patients to participate in decision-making and 2) reassure patients who may be skeptical?

2 Answers available

How do you perform geriatric assessment for cancer patients?

Do you use specific tools or take into account certain factors when considering treatment options for older adults?

1 Answer available

If a patient with recurrent endometrial cancer experiences minimal or slow disease progression on pembrolizumab or pembro/lenvatinib, would you consider continuing or would you change agents?

Patient has tolerated combination therapy well to date.

1 Answer available

How would you approach diagnosis of residual ovarian tissue in a patient with ER positive breast cancer, history of BSO, and a rising estradiol level on tamoxifen?

1 Answer available

Would you consider retrying a platinum based chemotherapy agent in a platinum resistant ovarian cancer patient?

3 Answers available

In what scenario would you prefer weekly vs every 3 week carboplatin/paclitaxel for high grade serous ovarian cancer?

3 Answers available

How are you counseling HR-proficient ovarian cancer patients about front line PARP inhibitor maintenance?

Given recent approval of niraparib (Zejula) for the maintenance treatment of adult patients with advanced epithelial ovarian, fallopian tube, or prima...

2 Answers available

How would you counsel a patient regarding possibility of ovarian preservation at time of surgery for malignant mesothelioma initially discovered in a myomectomy specimen and involving peritoneal surfaces?

Patient is 34yo and G0 referred from surgical oncology. Laparoscopic specimens of myoma and what appeared to be adhesions were significant for maligna...

1 Answer available

How does positive p53 staining influence your recommendation for adjuvant therapy in comprehensively staged early (stage IA or IB), grade 2, endometrioid endometrial cancers?

If patient meets high intermediate risk criteria, would you consider chemotherapy in addition to radiation?

1 Answer available

Would the presence of multifocal LVSI change your adjuvant treatment recommendation for a surgically staged IA dedifferentiated endometrial carcinoma?

Does not technically meet high intermediate risk criteria.

2 Answers available

In a patient with high-risk gestational trophoblastic neoplasia, how would you approach treatment of recurrence at 6 months post EMA-CO?

Tolerated first line, however now with rising Beta-HCG, new mass in uterus, and pulmonary metastases.

1 Answer available

How do you incorporate surveillance imaging for patients with ovarian cancer on maintenance therapy?

Does your strategy differ if the patient is on maintenance PARP inhibitor, bevacizumab, both, or neither?

1 Answer available

Do you re-test patients who test positive for COVID-19 during or prior to starting cancer treatment?

There are mixed recommendations about re-testing vs simply waiting for a quarantine period prior to resuming therapy.

2 Answers available

Would you consider HRT after BSO in a pre-menopausal gBRCA2+ patient who has no intention of ever having prophylactic bilateral mastectomies and who declines chemoprophylaxis?

2 Answers available

How would you manage a recurrent uterine leiomyosarcoma, now status post secondary cytoreduction, with no gross residual disease?

Would you consider adjuvant chemotherapy, radiation therapy, hormone therapy, or surveillance?

1 Answer available

Do you routinely prophylactically anticoagulate patients undergoing systemic chemotherapy outside of the perioperative period?

1 Answer available

How would you manage a young woman with vulvar langerhans cell histiocytosis and positive margins after wide local excision?

1 Answer available

Would development of a rectovaginal fistula mid-treatment with second line pembrolizumab/lenvatinib for endometrial cancer cause you to change regimens, eliminate lenvatinib, or continue current therapy?

The patient has a history of pelvic radiation and progressed through first line carboplatin/taxol. She has had a partial response to pembro/lenvatinib...

1 Answer available

How do you sequence chemotherapy with radiotherapy for advanced endometrial cancer?

4 Answers available

Are you offering PARP inhibitor alone or both PARP inhibitor and bevacizumab maintenance for HRD+ ovarian cancer patients after upfront treatment?

Based on recent PAOLA-1

1 Answer available

Are there scenarios that new visits/consults with patients can be done virtually amidst the COVID-19 outbreak?

6 Answers available

What adjuvant therapy would you offer a patient with Stage II uterine serous carcinoma without lymph node sampling?

3 Answers available

How do you approach the pharmacologic management of cancer-related fatigue?

After optimizing symptoms and reversible factors, and attempting cognitive-behavioral interventions and exercise, do you recommend pharmacologic agent...

2 Answers available

Would you offer adjuvant therapy following successful resection of a solitary lung recurrence of leiomyosarcoma if no other evidence of recurrent disease on PET CT?

1 Answer available

What starting dose of lenvatinib are you ultilizing in recurrent endometrial cancer patients initiating lenvatinib/pembro?

1 Answer available

Would you recommend systemic therapy in a patient with a history of Stage III high grade serous endometrial cancer s/p resection of a solitary pulmonary metastasis after a long disease free interval?

Does residual grade 1-2 neuropathy from Taxol/ carbo 10 years ago affect your recommendation?

2 Answers available

What upfront maintenance therapy would you recommend for a BRCA negative, advanced epithelial ovarian cancer patient after completing adjuvant carboplatin, paclitaxel, bevacizumab?

1 Answer available

Do you recommend concurrent chemotherapy with XRT for inoperable patients with stage I-II high-risk endometrial carcinoma?

Ie for patients who are inoperable due to comorbidities?

2 Answers available

Would you recommend maintenance therapy with a PARP inhibitor for BRCA+ patients with advanced uterine serous cancer?

Since no data exists or is pending, and the two disease processes are similar, should we consider PARP inhibition in this setting? This is assumi...

1 Answer available

How do you approach the decision of whether and when to initiate therapy in patients who remain COVID-19 positive >2 weeks after infection but are asymptomatic from the virus?

E.g. a patient with progression of their primary cancer but still is testing COVID19+ over a month after infection?

5 Answers available

How do you talk to patients about clinical trials?

I care deeply about clinical trials but have always struggled on how to approach this topic. I would really appreciate tips from those of you who have...

5 Answers available

Is there a Mednet app?

2 Answers available

When, if ever, would you recommend hysterectomy after chemoradiation for patients with locally advanced cervical cancer?

This has been a common practice in the community. Is there a benefit for certain patients?

2 Answers available

How do you manage taxane acute pain syndrome (TAPS)?

Can it be prevented? How do you evaluate patients? What non-pharmacologic or pharmacologic interventions do you use for treatment?

1 Answer available

Do you routinely prescribe anticoagulation for patients on active chemotherapy?

1 Answer available

How do you decide the right time to transition to hospice?

Obviously, patient and caregiver preferences are paramount. But, what factors do you consider? Does expanded hospice (e.g., Medicare Care Choices) inf...

4 Answers available

Would you give a PARP inhibitor, and at what dose, to a patient with end-stage renal disease on hemodialysis after completion of 6 cycles of carboplatin and paclitaxel for advanced ovarian cancer?

1 Answer available

Should our selection for neoadjuvant chemotherapy in ovarian cancer patients change in light of COVID-19?

1 Answer available

Are maintenance therapies for ovarian cancer being held at your institution due to COVID-19?

2 Answers available

Are you altering your use of immune checkpoint inhibitors given the risk of immune-related pneumonitis and the COVID-19 outbreak?

2 Answers available

How should you manage a COVID-19 infected/suspected patient who is receiving chemotherapy and cannot interrupt or delay their cancer treatment?

2 Answers available

How should you manage a coronavirus infected/suspected patient who is receiving radiotherapy and cannot interrupt or delay their cancer treatment?

How would you approach a patient who is receiving chemoRT but has confirmed COVID-19 with minor symptoms, as breaking treatment for 2 weeks quarantine...

7 Answers available

What are the current official guidelines regarding managing patients during COVID-19?

3 Answers available

Should I wear gloves during a routine physical exam on an asymptomatic patient with no risk factors for COVID-19?

1 Answer available

What measures should we take regarding routine follow-up visits for well patients in surveillance during the coronavirus pandemic?

When a physical exam is important and telehealth is not a good option, should we be proactive and reschedule or should we continue to see them as sche...

2 Answers available

In a patient metastatic recurrent endometrioid endometrial cancer who has a mixed response to carboplatin and paclitaxel, what is your next choice of therapy?

No adjuvant treatment was given upfront

1 Answer available

Is your approach to managing immune related adverse events altered at all in light of COVID-19?

2 Answers available

What adjuvant chemotherapy is preferred in primary ovarian mucinous adenocarcinoma of intestinal type?

2 Answers available

How do you explain progression free survival to patients?

5 Answers available

Before re-challenging a patient with ICI after grade 1-2 pneumonitis, do you re-image to confirm resolution of pneumonitis?

1 Answer available

Do you routinely offer PARP inhibitor maintenance therapy to germline BRCA1/2+, FIGO stage II serous ovarian carcinoma patients after adjuvant chemotherapy?

SOLO1 trial studied stage 3/4 patients.

1 Answer available

How do you approach adjuvant treatment of non-uterine leiomyosarcoma?

When, if ever, do you utilize adjuvant RT or chemotherapy?

2 Answers available

What is optimal timing or sequencing of therapy for patients with synchronous locally advanced triple negative breast cancer and ovarian cancer with peritoneal carcinomatosis?

2 Answers available

How would you manage a patient with synchronous breast and ovarian cancer, s/p neoadjuvant chemotherapy and surgery for ER+/HER2- breast cancer and found to have an ER+ ovarian cancer nodal metastases at TAH/BSO?

RP node with treatment related changes and surgical specimen from TAH/BSO no other foci of malignancy found.

1 Answer available

Do you recommend frontline bevacizumab with carbo/taxol in patients with advanced epithelial ovarian and BRCA mutation who will be receiving olaparib maintenance?

1 Answer available

In light of GOG-252, are there any situations where IP chemotherapy would be preferable following debulking of advanced epithelial ovarian cancer?

1 Answer available

When do you choose dose-dense chemotherapy v. q3 week therapy in advanced epithelial ovarian cancer?

1 Answer available

What is your preferred sequence of chemotherapy regimens after patients with metastatic endometrial cancer develop resistance to carboplatin + paclitaxel?

1 Answer available

How do you choose 1st line therapy for recurrent cervical cancer?

Would you be more or less likely to use a cisplatin-containing regimen if a patient had previously responded to chemoradiation with concurrent cisplat...

1 Answer available

How do you determine which systemic therapy to recommend in the 2nd line setting for metastatic, PD-L1 NEGATIVE cervical cancer?

1 Answer available

Would you recommend EBRT/brachythrapy for any patients with stage III- IV uterine ca in light of GOG-258 data?

https://www.nejm.org/doi/full/10.1056/NEJMoa1813181

1 Answer available

Do you consider tumor mutation burden as a possible biomarker for response to immune checkpoint therapy in the second line setting for cervical cancer?

1 Answer available

Is pembrolizumab considered standard of care in the 2nd line treatment of recurrent cervical cancer?

Does the phase II KN-158 provide sufficient evidence to change management?

1 Answer available

Would you recommend 1st line pembrolizumab for PD-L1 positive recurrent/metastatic cervical cancer patient who is not a candidate for or refuses chemotherapy?

1 Answer available

When do you recommend PD-L1 testing for patients with recurrent cervical cancer?

Should this be done at the time of recurrence or after failure of 1st line therapy for recurrence?

1 Answer available

How do you decide on adjuvant therapy in a patient with a Stage IA uterine carcinosarcoma without any myometrial invasion?

The NCCN recommends either systemic therapy + brachytherapy or pelvic RT + brachy or brachy alone or observation. How do you decide among these option...

1 Answer available

Do you recommend stopping olaratumab in patients receiving doxorubicin/olaratumab for treatment of advanced sarcoma?

Given the recent press release regarding the update on the phase 3 soft tissue sarcoma study of LARTRUVO (olaratumab) showing no benefit to the combin...

1 Answer available

For a patient with carcinosarcoma of the uterus and an allergic reaction to paclitaxel, would you have any reservations about using docetaxel instead?

1 Answer available

Now that there are three FDA-approved PARP inhibitors for use in ovarian cancer (niraparib, rucaparib, olaparib), how do you decide which one to use?

2 Answers available

Should olaparib maintenance therapy be recommended in patients with BRCA-positive, advanced ovarian cancer after first line platinum-based chemotherapy?

Should this be the new standard of care based on the results from the recently published SOLO-1 trial?

1 Answer available

When do you refer a patient with metastatic ovarian cancer for upfront debulking v. neoadjuvant chemotherapy?

1 Answer available

Should women with adequately debulked ovarian cancer receive bevacizumab with chemotherapy in the adjuvant setting?

3 Answers available

How do you determine the choice of therapy for platinum resistant ovarian cancer in healthy, good performance status patients?

Two new phase 2 studies this year with apatinib/oral etoposide (AEROC) and sorafenib/topotecan (TRIAS) were released, and NCCN also lists many single ...

3 Answers available

Do you recommend bevacizumab in platinum sensitive recurrences of epithelial ovarian cancer?

Or do you wait for platinum resistance?

1 Answer available

In patients with recurrent advanced ovarian carcinoma and a hypersensitivity reaction to platinum, do you prefer a desensitization protocol to maximize response or switching to a non-platinum regimen?

1 Answer available

Is it safe and/or necessary to combine osimertinib and carboplatin/paclixel for a patient with stage IV EGFR mutated NSCLC and advanced ovarian carcinoma?

Certainly ovarian cancer will respond to carboplatin and paclitaxel and it sounds like a reasonable chemotherapy to give to a stage IV NSCLC, however ...

1 Answer available

What is your approach to an optimally debulked patient with Stage Ia FIGO gr 3 serous carcinoma of the ovary?

Is it reasonable to use single agent carboplatin for elderly patients?

2 Answers available

Is further workup and management required for an incidentally found small focus of neuroendocrine tumor of the endometrium?

In a patient who underwent laparoscopy for endometriosis and was found to have a 1mm focus of neuroendocrine tumor, would you recommend further surger...

1 Answer available

What is the preferred second line agent for a woman with metastatic vulvar cancer who has progressed on carboplatin/paclitaxel?

She has metastatic disease beyond the pelvis (lungs).

2 Answers available

For a young patient with stage 4 endometrial cancer with an excellent response to anthracyclines, would you continue to give anthracyclines beyond the standard dosage cap if cardiac function remains normal by echocardiogram?

1 Answer available

How would you manage a patient with low-volume non-invasive endometrioid carcinoma that is found in both the endometrium and ovary (pN0)?

Would you approach this situation as synchronous primaries (eg. FIGO IA in both) or as a locally advanced endometrial cancer (FIGO IIIA)? What adjuva...

2 Answers available

Which chemotherapy regimen (if any) do you recommend for palliative concurrent chemoradiation for a symptomatic patient with metastatic cervical carcinoma and CKD stage 4 (GFR 15-29)?

1 Answer available

In what situations should chemotherapy be added to adjuvant radiation therapy in a resected vuvlar SCC?

Would you add chemotherapy if there was gross residual disease, pN+ and/or ECE?

2 Answers available

How would you treat small cell cancer of the cervix?

Can the classic indications for post-hysterectomy radiation (eg. "Sedlis" and "Peter's" criteria) be applied? Does the histology change radiation dose...

1 Answer available

Should I treat a patient who doesn't know she has cancer?

My patient’s family has asked that I don’t tell her that she has metastatic cancer because it will devastate her. I am planning on palliat...

2 Answers available

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Rucaparib maintenance treatment for recurrent ovarian carcinoma after response to platinum therapy (ARIEL3): a randomised, double-blind, placebo-controlled, phase 3 trial.

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Niraparib Maintenance Therapy in Platinum-Sensitive, Recurrent Ovarian Cancer.

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Mucinous epithelial ovarian cancer: a separate entity requiring specific treatment.

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An Outpatient, Dose-Intense, Intravenous Cisplatin and Oral Etoposide Regimen for the Treatment of Advanced, Platinum-Resistant Ovarian Cancer.

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Clinical response to antiestrogen therapy in platinum-resistant ovarian cancer patients and the role of tumor estrogen receptor expression status.

The New England journal of medicine, 2018-12-27

Maintenance Olaparib in Patients with Newly Diagnosed Advanced Ovarian Cancer.

Gynecologic oncology, 2018-10

Improved survival with adjuvant brachytherapy in stage IA endometrial cancer of unfavorable histology.

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Randomized Phase II Trial of Carboplatin-Paclitaxel Versus Carboplatin-Paclitaxel-Trastuzumab in Uterine Serous Carcinomas That Overexpress Human Epidermal Growth Factor Receptor 2/neu.

International journal of radiation oncology, biology, physics, 1994-06-15

Combined-modality therapy of esophageal cancer with radiotherapy, etanidazole, and cisplatin-fluorouracil, with or without surgery: neurotoxicity, other toxicities and outcome.

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Dose-volume analysis of radiation pneumonitis in non-small-cell lung cancer patients treated with concurrent cisplatinum and etoposide with or without consolidation docetaxel.

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Phase II trial of combined modality therapy with myeloid growth factor support in patients with locally advanced non-small cell lung cancer.

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Prospective Validation of Pooled Prognostic Factors in Women with Advanced Cervical Cancer Treated with Chemotherapy with/without Bevacizumab: NRG Oncology/GOG Study.

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Niraparib in Patients with Newly Diagnosed Advanced Ovarian Cancer.

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Olaparib plus Bevacizumab as First-Line Maintenance in Ovarian Cancer.

Science (New York, N.Y.), 2017-07-28

Mismatch repair deficiency predicts response of solid tumors to PD-1 blockade.

The New England journal of medicine, 2018-05-31

Nivolumab plus Ipilimumab in Lung Cancer with a High Tumor Mutational Burden.

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Safety and Efficacy of Pembrolizumab in Advanced, Programmed Death Ligand 1-Positive Cervical Cancer: Results From the Phase Ib KEYNOTE-028 Trial.

The New England journal of medicine, 2006-01-05

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Lancet Oncol, 2013 Sep

Long-term results of dose-dense paclitaxel and carboplatin versus conventional paclitaxel and carboplatin for treatment of advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer (JGOG 3016): a randomised, controlled, open-label trial.

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Impact of the addition of carboplatin and/or bevacizumab to neoadjuvant once-per-week paclitaxel followed by dose-dense doxorubicin and cyclophosphamide on pathologic complete response rates in stage II to III triple-negative breast cancer: CALGB 40603 (Alliance).

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Long-term results of early adjuvant concurrent chemoradiotherapy for high-risk, early stage uterine cervical cancer patients after radical hysterectomy.

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Mutations in Homologous Recombination Genes and Outcomes in Ovarian Carcinoma Patients in GOG 218: An NRG Oncology/Gynecologic Oncology Group Study.

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Adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3): final results of an international, open-label, multicentre, randomised, phase 3 trial.

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Immune checkpoint inhibitor-induced inflammatory arthritis persists after immunotherapy cessation.

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