Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What is your response to the question, "Is this terminal?"
Thanks for this question, it's really important. This question comes up in two distinct scenarios: when a person is first diagnosed and when a person is nearing the end of her life. Let's talk about them in sequence. 1). At diagnosis: When a person is first diagnosed, this question is part of "getti...
When, if ever, would you recommend risk reducing BSO in patients with moderate penetrance breast cancer germline mutations?
RAD51C, RAD51D, and BRIP1 are all associated with significant risks of ovarian cancer and are appropriate for consideration of prophylactic oophorectomy, albeit perhaps at a slightly later age than BRCA1 and BRCA2. ATM and PALB2 may be associated with ovarian cancer risks that are similar to that of...
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...
How do you manage moist desquamation when treating vulvar cancer?
My experience is largely limited to the treatment of gynecologic malignancies, with the treatment of vulvar lesions the most common reason for development of moist desquamation. The first goal, in my opinion, is to prevent development of moist desquamation as much as possible. Skin folds that are no...
Do you believe the collective data support neoadjuvant chemotherapy or primary debulking surgery for patients with advanced ovarian cancer?
At this time, primary debulking surgery should be applied whenever feasible. However, I think we still do a poor job of selecting patients for PDS versus IDS. We neglect (or do not know) how tumor biology is really affected by surgery. For instance, BRCA-mutated tumors are likely easier to accomplis...
How do you manage a FIGO stage IB dedifferentiated endometrial carcinoma that is MMR deficient and p53 wt?
Aggressive disease. Favor chemo plus IO (MMR-d) (Van Gorp et al., PMID 39284383) followed by EBRT.
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?
Reading the question at face value - does advanced endometrial cancer mean stage IVB? III/IVA? If IVB, there is not routinely a role of 'adjuvant' EBRT or BT.Given the discussion of adjuvant therapy, I presume the question is asking for the small fraction of RUBY and GY-018 patients who were stage I...
What is your strategy to help prevent paclitaxel-related neuropathy?
There are no proven strategies for prevention of CIPN and the use of these supplements is not recommended. Some supplements such as acetyl carnitine can actually worsen neuropathy outcomes and some supplements such as B12, vitamin C, and others may negatively interact with chemotherapy and worsen di...
Are maintenance therapies for ovarian cancer being held at your institution due to COVID-19?
Patient safety and health care worker safety are of the upmost importance for us. We are doing telehealth visits and able to deliver oral drugs to patient's homes. For infusion visits, those are being decided on a case by case basis, depending on the patient and their disease status.
Would you recommend 1st line pembrolizumab for PD-L1 positive recurrent/metastatic cervical cancer patient who is not a candidate for or refuses chemotherapy?
No. First-line pembrolizumab has not yet been approved for that indication in cervical cancer. It is being studied in Keynote-826.