Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
For a patient with adenosarcoma of the ovary with high grade sarcomatous overgrowth removed intact with appropriate oncologic surgery, is there any role for radiation?
I don't see a role for adjuvant RT in this case. Should she develop a pelvic-only recurrence, then RT would be an appropriate modality.
Given recent studies investigating ICI myocarditis biomarkers such as Temra CD8+ cells, is there now a growing selection of clinical biomarkers, besides BNP and troponin, being measured routinely in ICI myocarditis cases?
Since novel biomarkers are not yet clinically available in most practice settings, these are not yet routinely being checked though they certainly merit further investigation for diagnosis of ICI myocarditis. Currently, recommended biomarkers include indicators of cardiac injury (troponin, BNP or NT...
What intracavitary brachytherapy dose (and fractionation) would you recommend for stage I vaginal cancer post-resection with positive (R1) margins?
Presuming nodes have been addressed or don’t need to be addressed. For brachy alone cases, I have done 6 Gy x 6 to GTV area with MRI planning with the first 4 or 5 fractions treating longer length especially if has VIN for microscopic dose and disease.
Would you alter your treatment algorithm for uterus mesonephric-like adenocarcinoma?
Very rare entity and would follow management principles for high grade (g3) endometrial cancer.
Given the platinum drug shortage and the recently presented NOW trial, would you consider PARP inhibitor use in place of platinum-based chemotherapy for advanced ovarian cancer?
The NOW trial results are extremely exciting and add to the growing body of data challenging the traditional upfront platinum treatment paradigms in ovarian cancer. However, without randomized data comparing PARPi to platinum/taxane-based treatment, I would not yet utilize PARPi monotherapy in the n...
Has your preferred adjuvant treatment for IC mucinous ovarian cancer changed in response to the platinum chemotherapy shortage?
We previously offered observation to Stage IC low grade mucinous ovarian cancer so this has not impacted our decision.
How should PARP inhibitors be incorporated into clinical practice in later line/maintenance of platinum-sensitive ovarian cancer for PARP inhibitor-naïve patients?
Personally, if I have a PARPi naïve recurrent platinum-sensitive patient, I would have no hesitation in treating them as we did in these trials. The OS data and FDA action on the prior indications, in my opinion, was a reckless statistical exercise and potentially harmful to patients.
What outcome data do you view as most impactful to make treatment decisions regarding the use of PARP inhibitors in later line or recurrent ovarian cancer?
The crossover makes the OS data very hard, if not impossible, to interpret. The findings were not that parps for platinum sensitive maintenance for non-BRCAm were detrimental -- it was that they did not seem to show OS benefit. Certainly, treatment free intervals and quality of life are extremely im...
How do you counsel patients with homologous recombination repair proficient tumors already on niraparib maintenance therapy, prior to the FDA restriction?
In the NOVA trial, the PFS benefit for the BRCAwt/HRP patient sub-group was approximately 3 months. Given this small improvement in PFS, prior to the FDA restriction, I always had a risk/benefit discussion with patients reviewing this small benefit and whether the benefit outweighs the risks of trea...
In patient s/p definitive chemoRT for vulvar cancer with complete response, how do you manage a non-healing vulvar defect if biopsy is negative for residual disease?
Hard and takes time. Vitamin E with trental and quit smoking.