Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
When do you choose dose-dense chemotherapy v. q3 week therapy in advanced epithelial ovarian cancer?
In our recent OGR, we suggested an approach to deciding which patients might be appropriate for considering the dose-dense regimen in the first line setting (Figure 2). The dose-dense JGOG regimen was shown to confer an overall survival advantage in newly-diagnosed patients with advanced disease (es...
How should you manage a COVID-19 infected/suspected patient who is receiving chemotherapy and cannot interrupt or delay their cancer treatment?
This is difficult to answer specifically without further details. There certainly is accumulating evidence that patients with cancer, especially those receiving immunosuppressive chemotherapy, are at greater risk of COVID-19 infection if exposed, and a greater risk of serious and life-threatening co...
Before re-challenging a patient with ICI after grade 1-2 pneumonitis, do you re-image to confirm resolution of pneumonitis?
Grade 1 pneumonitis is defined as confined to one lobe of the lung or <25% of the total lung parenchyma, while grade 2 pneumonitis is defined as involving more than one lobe of the lung or 25-50% of the lung parenchyma. Grade 1 pneumonitis is typically an incidental finding on CT in an asymptomatic ...
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...
What is your current practice for obtaining mutation status for a patient with newly diagnosed ovarian cancer?
My current practice is to test all newly diagnosed epithelial ovarian cancer patients (includes fallopian tube and peritoneal) with both germline multigene and somatic multigene/NGS panels. Only recently have I adopted the practice of concurrent testing at diagnosis rather than basing the decision t...
How do you choose 1st line therapy for recurrent cervical cancer?
I use the Moore criteria and if the score is greater than or equal to 2, I will evaluate the patient for contraindications to bevacizumab and if none, I will counsel her to receive bevacizumab plus chemotherapy. The chemotherapy backbone is cisplatin-paclitaxel if the patient did not receive cisplat...
For an non-operative patient with IB1 cervical cancer, would you recommend RT alone or concurrent chemoRT for definitive therapy?
I usually favor RT alone as local control and the outcome is excellent unless they have adenocarcinoma, a suspicious pelvic node, or multiple high risk features (high grade with LVSI on bx).
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.
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.
For patients with cervical cancer who otherwise meet criteria for a simple hysterectomy based off SHAPE or GOG-0278 criteria, do you require negative margins on the excisional biopsy specimen to offer simple hysterectomy?
The choice to offer a simple hysterectomy to patients with early-stage cervical cancer is complex. SHAPE did not require negative margins on an excisional biopsy, but there were other key inclusion criteria that I think should be strictly followed if considering a simple hysterectomy. The lesion mus...