Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
In patients with recurrent MSI-H endometrial cancer on immunotherapy with pembrolizumab, when do you discontinue therapy?
If they have no evidence of disease on their scan, I stop at 2 years.
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?
For a patient with minimal toxicity and evidence of a partial response receiving pembrolizumab, it is reasonable to continue treatment with chemotherapy + bevacizumab + pembrolizumab for a few more cycles. For patients not receiving pembrolizumab, I would continue treatment until unacceptable toxici...
When, if ever, would you consider lenvatinib + pembrolizumab as first line therapy for patients with stage IV microsatellite stable endometrial cancer?
Outside of a clinical trial, I have not incorporated lenvatinib and pembrolizumab therapy as 1L therapy for pMMR endometrial cancer patients. This question will be answered by the LEAP-001 trial, which has completed accrual.
Do you add pelvic RT for stage II gr 2 endometrial cancers with multiple high risk features?
I would treat with pelvic adjuvant RT.Musunuru et al., PMID 35248784
Would you offer pelvic radiation in a patient with Stage IIIC endometrial cancer who has Crohn's disease and a permanent ileostomy?
I would avoid as the risk is more than the benefit and would consider brachy only.
In a patient with previous cervix cancer treated with surgery and adjuvant EBRT who presents with recurrent HGSIL, status post vaginectomy, would you consider brachytherapy?
I would consider advanced imaging such as MRI with vaginal gel to rule out the presence of a supravaginal lesion. Otherwise, I would not treat following excision of the HSIL lesion, even if margins were positive for dysplasia. HPV testing can be done to risk stratify. However, excision/ablation is t...
For which patients with stage IA nonsurgically staged endometriod cancer would you add pelvic RT?
At present, for most of these patients we would not add EBRT irrespective of nodal staging.The only subset where would consider EBRT is stage IA, grade 3 with LVSI, as they were underrepresented in PORTEC 2. In the ongoing PORTEC 3, they are treated like high risk with randomization between EBRT or ...
What pelvic fields do you treat for patients with FIGO IA2-IB cervical cancer patients who inadvertently get a simple hysterectomy but with lymph node sampling (for presumed endometrial carcinoma)?
This situation used to be referred to as a "cut-through" hysterectomy (even though the surgeon did not cut through tumor). The devil is in the details for something like this. How thorough was the dissection? How deep the invasion? However, some generalizations can be made. The upper 1/2 of the vagi...
Are there instances where you prefer an SBRT boost rather than a brachytherapy boost when treating definitive locally advanced cervical cancer?
No.
What is your process for obtaining and using next generation sequencing on patients with advanced endometrial cancer?
All patients initially have IHC done for MMR deficiency and then may go on to genetic testing, based on the results. Additionally, we send tumor to Foundation Medicine for sequencing which includes POLE mutations etc., and also for PDL1.