How would you approach a pre-viable pregnant patient in the second trimester with metastatic ovarian cancer who wants to keep the pregnancy?

I would recommend neoadjuvant chemotherapy and co-manage with maternal-fetal medicine to try to optimize the outcome for both mom and baby. Typically, we will start chemotherapy (platinum-based) after organogenesis is complete and continue q21 days until about 3-4 weeks before planned delivery. Once viable, the MFMs typically will start doing antenatal testing and monitoring for fetal growth restriction. We will monitor the cancer outcomes with non-contrast MRIs. Coordinating with MFM, we typically deliver early based on what is needed for mom and baby. Unless there is a limited tumor burden, I will generally continue the chemotherapy and then plan for an interval cytoreduction after recovery from pregnancy, but I could consider doing a cyt...