Do you recommend concurrent cisplatin and gemcitabine with radiotherapy for unresectable vulvar cancer, as described in GOG-279?

We are still doing weekly cisplatinum with a higher dose of RT as there is concern about additional morbidity with the addition of gemzar.

Richman et al., PMID 32981696

The rates of G4 toxicity with the addition of Gemcitabine are concerning to me. 18 out of 52 patients (34.6%) had G4 toxicity per the initial NRG press release. At the time, I figured a proportion of it was related to dermatitis.

Per the recently published JCO paper (Horowitz et al., PMID 38574312) just published, it does appear most of these were driven by blood count abnormalities without noted G4 dermatitis, so that is a bit reassuring. However, we are still doing Cisplatin alone currently.

Long-term, I do wonder if HPV- vulvar SCCs may benefit from intensification, rather than all comers, given the suggestion of differential dose response based on HPV status in vulvar SCCs (Horne et al., PMID 30082072) where HPV+ tumors are more likely to...