Gynecologic Oncology
Clinical discussions on gynecologic malignancies, surgical approaches, and multimodal treatment strategies.
Recent Discussions
How should you manage a COVID-19 infected/suspected patient who is receiving chemotherapy and cannot interrupt or delay their cancer treatment?
This is difficult to answer specifically without further details. There certainly is accumulating evidence that patients with cancer, especially those receiving immunosuppressive chemotherapy, are at greater risk of COVID-19 infection if exposed, and a greater risk of serious and life-threatening co...
Is your approach to managing immune related adverse events altered at all in light of COVID-19?
First of all, I wish to thank @Dr. First Last from Johns Hopkins/Sibley for his advice addressing this critical topic.We are all witnessing a rapidly evolving crisis that none of us have been prepared for and it is the right thing to quickly consider as best as we can how the COVID-19 pandemic shoul...
Do you recommend frontline bevacizumab with carbo/taxol in patients with advanced epithelial ovarian and BRCA mutation who will be receiving olaparib maintenance?
As shown in GOG-218, there is no apparent benefit to using concurrent bevacizumab with paclitaxel and carboplatin in the first-line setting, if this drug is not then continued during maintenance therapy. Our approach is to obtain genetic testing in patients with epithelial ovarian cancer as soon as ...
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 do you decide until what age to offer ovarian preservation for patients with biopsy-proven grade 1 or grade 2 endometrial cancer without evidence of metastatic disease on imaging or at the time of surgery?
I often reference Jason Wright's article evaluating the safety of ovarian preservation up to age 45 regarding cancer-related mortality. Granted, this doesn't measure recurrence rates. I also reference Dr. Barakat's incomplete GOG study (a casualty of the WHI study) that found only ~2-3% of patients ...
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.
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).
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 light of DESKTOP III, how will you approach secondary debulking for platinum sensitive epithelial ovarian cancer patients?
Well, it certainly does make things interesting. GOG 213, reported in the NEJM (Coleman RL et al., NEJM 2019), was a similar randomized phase III trial and included patients with resectable platinum sensitive recurrence who were randomized to secondary cytoreduction + chemo, vs chemo alone. The inve...
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.