Medical Oncology

Gynecologic Cancers   

Questions discussed in this category



What are your volumes and dose/fractionation for external beam boost in lieu of tandem and ovoid or tandem and ring implant?

Would you consider the addition of carboplatin/paclitaxel + dostarlimab to radiation as opposed to radiation alone?

Would you consider this stage IVA (spread to adjacent organ) or IVB (spread to distant organ)? For instance, would the presence of direct lumbar verte...

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...

The 4 cm cuff recurrence occurred 3 years after definitive treatment with hysterectomy and vaginal cuff brachytherapy to 21 Gy. The recurrence had a c...

Would your management change given that this recurrent lesion is over 10 cm and the patient previously achieved complete response on immunotherapy 5 y...

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

This would apply to gynecologic and GI cancers as well. And as long as the patient's partner is within the recommend age of <45 yo

There was a recall on viscous lidocaine and many of our patients cannot find it. What would you recommend as alternatives?

The patient is a female in her 40s. No mucosal changes were evidenced on clinical exam. Chemo-RT is recommended by GynOnc at an academic center. ...

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

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 ...

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...

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

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...

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 ...

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

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...

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

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...

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

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

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

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

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...

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

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

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

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

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...

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

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

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

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

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

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

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

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

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

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

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 ...

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

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

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

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

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

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

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...

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

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

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

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

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

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

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

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

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

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

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

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

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...

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

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

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

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

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

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

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

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 ...

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

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...

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

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

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

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

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

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

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

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

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

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

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

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...

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...

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

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

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

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...

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...

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

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

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

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...

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

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

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

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

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

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


Papers discussed in this category


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JAMA,

JAMA Netw Open, 2021 Apr 01

Gynecologic oncology, 2010-03

The New England journal of medicine, 2019-06-13

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Gynecol Oncol, 2019 Sep

Gynecologic oncology, 2004-04

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Gynecologic oncology, 2015-06

The Lancet. Oncology, 2017-09

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Gynecologic oncology, 2015-09

Curr Oncol Rep,

Adv Anat Pathol,

Gynecologic oncology, 2014-11

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Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-06-01

The New England journal of medicine, 2011-12-29

N Engl J Med, 2011 Dec 29

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Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2012-06-10

Lancet Oncol, 2017 Jun

Lancet (London, England), 2017-10-28

The New England journal of medicine, 2016-12-01

The New England journal of medicine, 2012-04-12

J. Clin. Oncol.,

J Clin Oncol, 2014 May 1

Int J Gynecol Cancer, 2018 Mar

Br. J. Cancer,

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 2015-02

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

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

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J. Clin. Oncol., 2019 Apr 19

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-01-01

Lancet Oncol., 2014-06-01

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Ann Surg Oncol, 2014 Aug

Cancer,

American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting, 2018-05-23

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Br. J. Cancer, 2009 Feb 17

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BMC Cancer, 2019 Mar 11

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J Clin Oncol, 2020 Feb 10

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Br. J. Cancer, 2018 Oct 24

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J Clin Oncol,

Breast Cancer (Dove Med Press), 2017 Jan 23

J. Clin. Oncol., 2011 Mar 28

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J Clin Oncol, 2020 Apr 10

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F1000Res, 2019 Jun 12

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The New England journal of medicine, 2019-02-21

J Thromb Haemost, 2019 Jul 28

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JAMA,

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Gynecol Oncol Rep, 2020 Jan 30

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Lancet (London, England), 2017-10-07

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-06-10

J Clin Oncol, 2019 Nov 04

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Gynecol Oncol, 2020 Jul 9

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The New England journal of medicine, 2016-07-14

Practical radiation oncology, 2021 Sep-Oct

Palliative medicine, 2022 Mar 31

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2023 Mar 28

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Int J Gynecol Cancer, 2020 Dec 18

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