Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
What are magic mouthwash alternatives that you would recommend?
Many of our patients will make their own DIY MMW per Phil's My Pharmacist (YouTube) instructions -- uses benzocaine/Cepacol lozenges -- they say it's much more effective than the compounded one from the pharmacy. It is also more economical.If the majority of bothersome mucositis is in the oral cavit...
Do you routinely offer PARP inhibitor maintenance therapy to germline BRCA1/2+, FIGO stage II serous ovarian carcinoma patients after adjuvant chemotherapy?
We are not offering PARPi maintenance in early stage disease at this time. We are in line with the data showing benefit in advanced stage disease. While the data are compelling, you must remember that that these medications 1) have side effects including risk of MDS and 2) can be used in the recurre...
Would you recommend PARP inhibitor maintenance for a patient with HR-proficient ovarian cancer with no targetable mutation, but with a favorable KELIM score and a significant clinical, radiographic, and serological response to platinum-based chemotherapy?
To date, the clinical trials that have included biomarkers for response to PARP inhibitors have shown that those with BRCA pathogenic variants appear to have the largest benefit followed by those with HRD tumors; however, these do not account for all the individuals who have disease that could benef...
With immunotherapy now often being used in the first-line setting for advanced endometrial cancer, what is the role of immunotherapy in the second-line?
This is a relevant and important question that we have yet to definitively answer. Furthermore, it may depend on several factors such as progression while receiving front line maintenance immunotherapy versus progression after completion of maintenance treatment, or progression after discontinuation...
What is the appropriate timing for adjuvant radiation for vulvar cancer?
You follow the same principle as other squamous cell cancers to start within 6 weeks for surgery but sometimes are limited by post-op healing. Ashmore et al., PMID 33500149
What role does radiation plan in a pT1a endometrial cancer with two small metastatic foci in the abdomen found during surgery?
I see the limited value of prophylactic RT here and favor systemic treatment only.
What adjuvant therapy would you recommend for a patient with high grade serous ovarian cancer who has surgically confirmed unresectable disease after a partial response to 6 cycles of a platinum doublet?
This decision would depend on several factors; the patient's frailty status, disease spread, molecular signatures, and response thus far. If she continues to respond well to the platinum couplet, my approach would involve adding bevacizumab if it hasn't been administered yet. I might also consider a...
How do you manage taxane acute pain syndrome (TAPS)?
A number of pharmacological agents have been reported as options for TAPS. These include NSAIDs, steroids, antihistamines, tricyclic anti depressants, antiepileptics, and glutamine. I have used most of these except glutamine, with moderate success. I usually start with NSAIDS and consider adding sho...
Is there evidence to suggest that whole pelvic radiation is immunosuppressive and may lead to worse outcomes in the setting of chemoIO treatment for stage III endometrial cancer?
There is data showing lymphopenia with pelvic RT but no outcome data showing it will have worse outcome with IO. Rather, a GOG study for concurrent chemo RT plus IO shows improvement in outcome in comparison to chemo RT alone leading to approval of the use of pembro for stage III and IVa cervical ca...
When can abdominal surgery be safely performed for presumptive ovarian cancer in a patient with recent pulmonary emboli?
In general, the standard approach is to try to wait as long as possible after the thrombotic event, at the very least three months. This may not be possible, we then reduce that time interval to one month. Given the urgent nature of the surgical intervention, one approach is to wait one month and co...