Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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 ...
How would you manage a Stage IB endometrioid endometrial cancer, status post staging surgery, with a rapid vaginal recurrence <1 month post operatively?
A rapid recurrence like this is unusual, but we have definitely seen it. Cuff recurrences require multidisciplinary management. The most worrisome feature of this patient is the rapidity of recurrence. For the initial management, I would probably have recommended some kind of adjuvant treatment afte...
What chemotherapy regimen would you utilize for a metastatic, poorly differentiated carcinoma of the cervix with neuroendocrine features?
I would work with pathology to define if this is a true neuroendocrine cervical cancer versus a poorly differentiated cervical carcinoma with neuroendocrine features. This could potentially impact treatment decisions. I treat patients with poorly differentiated metastatic cervical carcinoma with the...
What are your top takeaways from SGO 2022?
So many great presentations at SGO 2022! The depth of the science was amazing and the ability to co-mingle in person with new friends and colleagues was more than fabulous. Although I am asked to discuss 3 pivotal abstracts, I encourage all readers to review the many great presentations via the “OnD...
What are your top takeaways in Gynecologic Cancers from ASCO 2023?
Gynecologic oncology research was strong at ASCO 2023. Results of the following 3 pivotal studies are practice changing. Marie Plante, MD: SHAPE trial: This non-inferiority CCTG (Canadian Cancer Trials Troup) trial enrolled 700 patients with low-risk squamous cell carcinoma, adenocarcinoma or adenos...
What adjuvant therapy would you offer a patient with Stage II uterine serous carcinoma without lymph node sampling?
Since the major concern for UPSC is distant mets, these patients typically first receive 6 cycles of carboplatin/taxol after surgery at our institution. If the patient tolerates it without significant toxicity and re-staging scans are clear, we would then offer whole pelvis RT (45 Gy in 25 fractions...
Would development of a rectovaginal fistula mid-treatment with second line pembrolizumab/lenvatinib for endometrial cancer cause you to change regimens, eliminate lenvatinib, or continue current therapy?
These complications are always difficult situations. Given she is having a response to therapy and her disease is not curable, I would have a discussion with her about the option of diversion with a colostomy after imaging and discuss holding therapy perioperatively but would consider restarting aft...
How would you treat/counsel a patient with Stage IB3 SCC of the cervix who is 18 weeks pregnant and desires to maintain pregnancy?
Difficult situation. The patient should be offered termination of pregnancy. If that is not the patient's choice, or if it is not a possibility, then I would suggest surgical lymphadenectomy as a first step. If nodes are negative, one can consider neoadjuvant chemotherapy with platinum based chemot...
How do you approach systemic treatment for endometrial endometrioid adenocarcinoma with neuroendocrine differentiation?
We treat these as endometrioid primary as the histologic diagnosis states, "endometrioid endometrial adenocarcinoma with neuroendocrine differentiation" instead of "primary neuroendocrine carcinoma of the uterus." Therefore, follow the literature from GOG 209 to support carboplatin/paclitaxel, espec...
What is the optimal approach for a younger female with borderline resectable cervix cancer who may need adjuvant radiation, in light of a medical history significant for ulcerative colitis?
It all depends on the colitis status on therapy including the extent and response to ongoing treatment. No induction chemo. Either radical hysterectomy with the possibility of adjuvant RT or definitive RT based on colitis status. If high risk with RT, would proceed with surgery.