Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
For patients with advanced endometrial cancer, are the improved outcomes in PFS from DUO-E/RUBY/NRG-GY018 sufficient to move immunotherapy to the frontline for all presuming FDA approval?
The standard of care for metastatic endometrial cancer is systemic therapy with chemotherapy and now with or without immunotherapy. With this approach to therapy, there is a roughly 70% reduction in the risk of progression or death across three separate trials for the dMMR population (RUBY, GY018, A...
For a patient with IIIC endometrial adenocarcinoma diagnosed and treated with 6 cycles of Carboplatin/Paclitaxel two years prior, would you consider maintenance therapy with PD-L1 inhibition, given results of GY018 and RUBY?
Endometrial cancer incidence is increasing in the United States, and very little improvement in survival has been noted for advanced disease until recently. Monotherapy with immune checkpoint inhibitors have offered hope for patients with recurrence, and the recent publication of GY018 and the RUBY ...
What adjuvant therapy would you recommend for a Stage IIIC low grade serous ovarian cancer following following fertility sparing surgery?
Two observational studies guide our recommendations related to this question. In a report of 203 women with stage II-IV low-grade serous carcinoma of the ovary/peritoneum who underwent primary cytoreductive surgery, 133 underwent platinum-based chemotherapy followed by observation, and 70 underwent ...
How soon after pelvic RT can a routine colonoscopy be completed?
I have had them get it done once acute side effects subside in 8 -12 weeks. I do inform them about avoiding rectal biopsy and informing endoscopist about it.
How have you incorporated mirvetuximab into the treatment of platinum-resistant ovarian cancer?
This question is going to be increasingly important in the current landscape of ovarian cancer management. I have prioritized early ordering of biomarker testing so that I have the test profiles available at recurrence, particularly in the platinum-resistant standpoint.I find that toxicity, patient ...
How do you interpret the findings from TroFuse-005 and, assuming future FDA approval, how would you incorporate sacituzumab tirumotecan (sac-TMT) into treatment options for previously treated advanced or recurrent endometrial cancer?
I think sac-TMT is likely a good option for patients progressing on immunotherapy maintenance. I wonder if it is best for biomarker-positive patients (TROP-2 intermediate or high expression) and not as good for patients with high-risk histologies (carcinosarcoma) and/or TROP-2–low expression. I must...
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 approach to IV fluid management for the treatment of hypercalcemia of malignancy?
At this point, I believe one can use either saline or lactated Ringer's. There is some evidence that low-chloride-containing solutions have advantages in general, which may well be the case, but we need more data on that. The amount of calcium in LR is very small and should not make a difference (1....
How do you logistically incorporate a "scope and score" of a patient with newly diagnosed advanced ovarian cancer into a busy OR schedule?
This can definitely be tricky. In my practice, I typically scope and score the same day as I plan to do their debulking surgery, booking cases like this as the last case of the day. While I do have block time in the OR, it is hard to take a patient for scope and score to then return in a short inter...
When would you consider tapering glucocorticoids in a patient with ICI-associated myocarditis?
Once troponins start to decrease, I start the steroid taper and follow troponin levels. If they rise, I slow the taper. I also get serial ECGs, esp if there were arrhythmia manifestations of myocarditis. Don't forget to assess for the need for PJP prophylaxis with Bactrim or pentamidine and PPI sinc...