Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
When do you choose dose-dense chemotherapy v. q3 week therapy in advanced epithelial ovarian cancer?
In our recent OGR, we suggested an approach to deciding which patients might be appropriate for considering the dose-dense regimen in the first line setting (Figure 2). The dose-dense JGOG regimen was shown to confer an overall survival advantage in newly-diagnosed patients with advanced disease (es...
When do you recommend PD-L1 testing for patients with recurrent cervical cancer?
I think getting the testing done as soon as possible is best because very few patients will only need first line therapy. This way, there is less of a delay at the time of progression following/during first-line therapy.
How do you choose 1st line therapy for recurrent cervical cancer?
I use the Moore criteria and if the score is greater than or equal to 2, I will evaluate the patient for contraindications to bevacizumab and if none, I will counsel her to receive bevacizumab plus chemotherapy. The chemotherapy backbone is cisplatin-paclitaxel if the patient did not receive cisplat...
In a female patient in her 50s with ovarian cancer who developed a whole-body rash and lip swelling 7 days after her first cycle of carboplatin, paclitaxel, and bevacizumab, how would you proceed with pretreatment for cycle 2, assuming this was a delayed reaction to carboplatin or paclitaxel?
It is very important to characterize any delayed rash after treatment with its timing, morphology, severity, and whether features of a severe cutaneous adverse reaction are present. A benign delayed rash is the most common scenario and can generally be treated with symptomatic management and enhance...
Would you recommend 1st line pembrolizumab for PD-L1 positive recurrent/metastatic cervical cancer patient who is not a candidate for or refuses chemotherapy?
No. First-line pembrolizumab has not yet been approved for that indication in cervical cancer. It is being studied in Keynote-826.
For an non-operative patient with IB1 cervical cancer, would you recommend RT alone or concurrent chemoRT for definitive therapy?
I usually favor RT alone as local control and the outcome is excellent unless they have adenocarcinoma, a suspicious pelvic node, or multiple high risk features (high grade with LVSI on bx).
Is pembrolizumab considered standard of care in the 2nd line treatment of recurrent cervical cancer?
The phase II Keynote-158 indication is based on objective response of 14% in patients with PD-L1+ tumors. The US FDA approval is accelerated approval meaning that there needs to be a confirmatory trial - this is Keynote 826 which is ongoing.
What screening tools or signs do you use to predict if a cancer patient is near end-of-life?
For most of us, long-time practicing oncologists, all we have to do to determine that one of our patients is at the end of their life is to be in the same room with them. No special computer programs or calculators are needed. Just look closely at the patient's current weight, their level of conscio...
How do you determine which systemic therapy to recommend in the 2nd line setting for metastatic, PD-L1 NEGATIVE cervical cancer?
This is a very difficult situation because none of the available options are effective. Clinical trial or possibly pembrolizumab on compassion-care usage.
How would you manage a small posterior vaginal defect noted at the time of cervical brachytherapy?
If it is from a disease, I would continue brachy as planned and address the defect based on response and healing. If unrelated to disease, I would have it sutured and continue brachy as planned.