Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
Are you altering your use of immune checkpoint inhibitors given the risk of immune-related pneumonitis and the COVID-19 outbreak?
The management of advanced cancer patients has gotten even more complex with the COVID-19 pandemic. In general, providers are trying to keep patients away from the hospital/clinic as much as possible, and avoiding regimens with greater toxicity if there are suitable less toxic alternatives. Whether ...
What are your top takeaways in Gyn Cancers from ESMO 2025?
Studies presented at ESMO 2025 give a glimmer of hope to patients with platinum-resistant ovarian cancer, an area of gynecologic oncology where too little progress has been made. There were also numerous trials (too many to discuss here) presented involving ADCs, along with important updates to prev...
What is the optimal interval between vaginal cuff brachytherapy sessions?
At MD Anderson, we give 6 Gy x 5 to the surface and we most often treat every other day. However, given the low risk of toxicity, we think it's safe to make adjustments to this schedule. For example, we often do some treatments on sequential days if that's preferred for any reason. We also schedule ...
Have you had patients who wish to take ivermectin and/or fenbendazole as adjunct treatments for gynecologic cancers, and if so, how have you handled this?
Since COVID, there are definitely more patients interested in ivermectin and/or fenbendazole, as well as other alternative therapies. I will counsel the patients on the data for standard of care therapy, but also acknowledge that it is also their body, their life, and ultimately their choice what tr...
How do you decide until what age to offer ovarian preservation for patients with biopsy-proven grade 1 or grade 2 endometrial cancer without evidence of metastatic disease on imaging or at the time of surgery?
I often reference Jason Wright's article evaluating the safety of ovarian preservation up to age 45 regarding cancer-related mortality. Granted, this doesn't measure recurrence rates. I also reference Dr. Barakat's incomplete GOG study (a casualty of the WHI study) that found only ~2-3% of patients ...
How do you determine the choice of therapy for platinum resistant ovarian cancer in healthy, good performance status patients?
Platinum-resistant epithelial ovarian cancer is generally defined as relapse less than 6 months following completion of primary or the last platinum-based chemotherapy regimen. Options for therapy include conventional, commercially available drugs or potential clinical trials. If prior genetic testi...
Do you typically recommend avoiding neupogen during radiation treatments?
It depends on the reason and expected benefit. If myelosuppression is holding up RT for cervical cancer patients, then I would not hesitate to give neupogen to avoid or minimize a treatment break. There would be more benefit to neupogen and continuing RT than a downside. Usually, I would try to give...
How do you counsel patients about prognosis with FIGO 2018 IIIC cervix cancer managed in the new era of chemoradiation plus immunotherapy?
The prognosis is still a function of nodal location, number of nodes, local T stage, histology, and response to the EBRT portion of treatment. The local control is closer to 90% with a predominant pattern of failure being distant (around 20-25%). Also based on A-18, 3 years PFS is around 70% and OS ...
For a patient with IIIC1 (micromets), MSI-high, Grade 2 endometrial adenocarcinoma who has undergone full surgical staging, do you recommend adding immunotherapy to adjuvant chemotherapy + radiation?
Short answer: No, I do not recommend adjuvant CT/IO + RT for this patient based on the patient's risk factors in the prompt, and the data below. Should the patient have recurrent/metastatic disease following adjuvant CT + RT/VCBT, then I/O + CT is a good option. Ongoing trials hope to answer this qu...
For a patient with locally current endometrial cancer whose disease had complete radiographic response to carboplatin, Taxol, and pembrolizumab, would you consider adding radiation therapy?
Despite having a complete response to chemoimmunotherapy, I would tend toward adjuvant RT since this was a local recurrence. We don't have long-term data with chemoimmunotherapy in this locally recurrent setting.