Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Would you transition from denosumab to anabolic agents in patients who are in urgent need for extensive dental work?
From my experience, this is a catch-22. If you stop the Denosumab you will markedly increase osteoclastic activity throughout the entire skeleton which is why it is recommended that you not stop the medication without some other intervention. I have had several patients with either osteonecrosis of ...
What would you recommend for early stage vulvar cancer with close margins?
With negative sentinel LN's in an early stage patient, I would try to avoid the use of radiation if possible. Re-excision with a clear margin of 1-2 cm, extending to the deep perineal fascia, should be adequate to give a high rate of local control and cure, in the absence of other negative prognosti...
What are your top takeaways in Gyn Cancers from ESMO 2024?
Ovarian CA (Immunotherapy) There has been limited success with single agent immunotherapy in ovarian cancer. Three ovarian cancer immunotherapy studies presented at ESMO 2024 are worth noting.ATHENA-COMBO: Rucaparib +/- Nivo as Maintenance in Newly Diagnosed Ovarian Cancer - ATHENA-COMBO Ph3 TrialA...
Would you ever re-treat recurrent ovarian cancer with mirvetuximab soravtansine if the patient responded to it in the past (e.g., more than 6 months ago)?
As far as I know, there is no data on the repeat use of mirvetuximab for women who have progressed on prior treatment. I would tend to use cytotoxic therapy in this setting, but if the patient tolerated it well previously and has a good performance status, a short trial of repeat mirvetuximab seems ...
How would you manage a young woman with vulvar langerhans cell histiocytosis and positive margins after wide local excision?
It is a complex situation/question, with no major existing studies to answer it directly. Further management depends on various factors- are there other sites of disease on full-body PET CT scan? Is further surgery possible without any disfigurement or major cosmetic issues? If localized disease onl...
How would you treat IIB ovarian carcinosarcoma which recurred locally at 1 month post initial debulking surgery, progressed through 2 cycles of adjuvant carbo/taxol, and is now s/p repeat debulking?
Platinum refractory ovarian cancers are incredibly challenging. In terms of more conventional chemotherapy options and based on the AURELIA trial, one could consider bevacizumab in combination with pegylated liposomal doxorubicin or topotecan. I would not use paclitaxel since the cancer is progressi...
What are your top takeaways from SGO 2024?
SGO 2024 was a great meeting with many excellent presentations. We are truly “moving the needle together”. The following presentations are each practice changing. Duska et al., PMID 38521086: Pembrolizumab plus chemoradiotherapy for high-risk locally advanced cervical cancer: randomized, double-bli...
What are your top takeaways in Gyn Cancers from ASCO 2024?
ASCO 2024 was a quiet year for the gynecological cancer community without too many fireworks. For the radiation oncologists, there were very few positive studies. I will highlight a few important ones 1. Oral abstract #5504 was on “Adjuvant chemotherapy following concurrent chemoradiation (CRT) in p...
What techniques do you use to address fertility preservation in young female patients being treated with chemoradiation therapy for cancer in the pelvis?
The most important aspect of a fertility preservation strategy is to think of it early on in the discussions with your patient. Many medical centers now have a clinic or center to which patients can be referred and seen within several days. They are experts at explaining the options and outcomes wit...
What is the role of EBRT/brachytherapy (as an addition to chemotherapy) in the adjuvant management of optimally debulked stage IV uterine serous carcinoma?
There is no prospective study in this setting and based on limited retrospective data we do consider adjuvant RT for optimally debulked (meaning no macroscopic disease left behind after surgery) disease. We do consider pre surgery bulk of disease in decision making and would recommend RT for those w...