Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Do you recommend frontline bevacizumab with carbo/taxol in patients with advanced epithelial ovarian and BRCA mutation who will be receiving olaparib maintenance?
As shown in GOG-218, there is no apparent benefit to using concurrent bevacizumab with paclitaxel and carboplatin in the first-line setting, if this drug is not then continued during maintenance therapy. Our approach is to obtain genetic testing in patients with epithelial ovarian cancer as soon as ...
How do you determine which systemic therapy to recommend in the 2nd line setting for metastatic, PD-L1 NEGATIVE cervical cancer?
This is a very difficult situation because none of the available options are effective. Clinical trial or possibly pembrolizumab on compassion-care usage.
Is pembrolizumab considered standard of care in the 2nd line treatment of recurrent cervical cancer?
The phase II Keynote-158 indication is based on objective response of 14% in patients with PD-L1+ tumors. The US FDA approval is accelerated approval meaning that there needs to be a confirmatory trial - this is Keynote 826 which is ongoing.
Do you routinely check tumor genomics, including POLE status for new endometrial cancers?
Update provided March 23, 2026This is a great question for two main reasons: Resource utilization What am I going to do with the data I would choose to send POLE testing on patients where you think the data might impact your care... the challenge with that is that we lack strong prospective data to ...
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?
This is an interesting question, for which I don't have a quick answer.When it comes to PARP inhibitors (PARPi), there is compelling data for its use as maintenance therapy as well as recurrent treatment. The article by Kurnit et al., is a nice summary of the data available supporting PARPi use (Kur...
How would you plan your treatment for a locally advanced uterine cancer where there was intraoperative evidence of multiple rectal nodules that are biopsy positive?
After completion of systemic therapy while the patient is getting immunotherapy I would perform staging imaging and if negative I would treat the entire pelvis and the mesorectum including the distal rectum to the full adjuvant dose of 50 Gy in 25 fractions. The patient would continue immunotherapy ...
How would you manage a small posterior vaginal defect noted at the time of cervical brachytherapy?
If it is from a disease, I would continue brachy as planned and address the defect based on response and healing. If unrelated to disease, I would have it sutured and continue brachy as planned.
In light of DESKTOP III, how will you approach secondary debulking for platinum sensitive epithelial ovarian cancer patients?
Well, it certainly does make things interesting. GOG 213, reported in the NEJM (Coleman RL et al., NEJM 2019), was a similar randomized phase III trial and included patients with resectable platinum sensitive recurrence who were randomized to secondary cytoreduction + chemo, vs chemo alone. The inve...
What are the current official guidelines regarding managing patients during COVID-19?
Here are some guidelines and FAQ from professional societies: NCCN: https://www.nccn.org/covid-19/default.aspx ASTRO FAQ: https://www.astro.org/Daily-Practice/COVID-19-Recommendations-and-Information/COVID-19-FAQs ASCO Coronavirus Resources: https://www.asco.org/asco-coronavirus-information
Are there scenarios that new visits/consults with patients can be done virtually amidst the COVID-19 outbreak?
Starting 3/16, we began offering lower-complexity / lower-risk patients the option of having a Tele-medicine consult vs re-scheduling to a later date. This offer has been extended broadly to all new consults at our facility when the provider indicates that s/he can extend comparable service virtuall...