Ovarian Cancer   

Is there any evidence to suggest it matters if you use tissue from their initial biopsy/surgery vs tissue obtained from a new biopsy at recurrence?

Do you think it works better if incorporated as early as possible in the patient's course, or is it better to "save it" for future recurrences after u...

If someone progressed on mirvetuximab, would you consider adding bevacizumab before discontinuing mirvetuximab?

In particular, have you seen dose-limiting diarrhea, ocular toxicities, or infusion reactions? 

For some patients, it may be overburdensome to make an extra trip to an ophthalmologist every other cycle. They may live far away from an ophthalmolog...

What is your general philosophy when discontinuing and/or switching chemotherapy in the recurrent setting? 

If so, what dose would you treat to the resection bed? 

Does your surgical approach vary based on patient age, comorbidities, or tumor type?

Since there is no overlap between chemo regimens for these cancers, how would you sequence treatment? 

If you do not review all imaging, how do you triage for which studies you personally review the images vs. the written interpretation only?

Do you extrapolate from first line maintenance studies for duration of therapy?

Would your recommendation change if the patient was platinum-resistant?

Front-line PARP inhibitor maintenance therapy discontinued without progression.

Considering updated trials, such as final OS data from NOVA, and recent society guideline updates?

Given the crossover that occurred in the various clinical trials and the potential for prolonged disease duration, how do you integrate OS, PFS, treat...

Does your approach change depending on the patients initial somatic BRCA status?

Does not involve surface surface of the ovary, no gross disease elsewhere. 

Do you offer 3 or 6 cycles of chemotherapy? Would you ever observe?

Imaging reveals no evidence of disease. 

In your practice, what is the proportion of patients receiving neoadjuvant chemotherapy who are diagnosed with VTE? Does this differ from patients rec...

Would your systemic therapy choice be more similar to treatment of ovarian carcinoma or soft tissue sarcoma?

How would you approach the treatment if the tumor is PDL1+?

How does your approach vary based on residual disease left at the time of surgery? Please specify your approach for the amount of residual disease at ...

Do you prophylactically start all patients on B12, B-complex, and/or omega-3? If so, what dose? What about ice mittens and booties?

Considering the treatment of platinum resistant ovarian cancer as done in the AURELIA trial (Pujade-Lauraine et al., PMID 24637997).

Most interested in patient cohorts who have not demonstrated a good response to chemotherapy as measured by imaging and/or clinical/serological findin...

Would you perform oophorectomy of the other ovary and an appendectomy?

Presented with 8cm pelvic mass and had large omental cake + significant carcinomatosis on diagnostic lap. Biopsy ultimately resulted non-epithelial ov...

Assuming low risk of progression to AML and eligible for low-risk chemotherapies per hematologic/oncology.

https://pubmed.ncbi.nlm.nih.gov/34874631/

Genes such as ATM, CHEK2, PALB2, RAD51C/D, BRIP1 seem to show some potential increased risk of ovarian cancer. Should these patients under prophylacti...

For a young patient that underwent fertility sparing surgery for immature teratoma of the ovary, would you treat until tumor markers normalize even if...

Is there any role for completion surgery and/or RT in addition to chemotherapy? 12cm mass on ovary s/p TH/USO and preservation of grossly normal cont...

For instance, in patients that have not had neoadjuvant chemotherapy

Excellent KPS and long disease free interval from initial diagnosis. Initial recurrence 3-4cm at level of renal vessels and down to 1.3cm after chemo.

s/p optimal debulking. If this was an early-stage cancer would it change your adjuvant therapy recommendations?

Recurrence picked up incidentally on CT. No germ line mutations, somatic tumor testing of node resulted negative. PET confirmed isolated recurrence

30cm tumor, intraoperative rupture, all abdomino-pelvic surfaces and structures appeared free of disease.

Primary, R0 debulking in 2019, stage IA. Low volume recurrence, now again optimally cytoreduced. 

Does your practice vary based on risk status (low vs high risk) or specific mutation status (BRCA+ vs HRD+) given PAOLA subset analyses? 

What specific platforms for determining somatic BRCA and HRD status do you use for a patient who does not carry a germline BRCA mutation?

Are there clinical factors which help stratify? Does your practice vary based on mutation status (BRCA+ vs HRD+?)

How do the 5 year results of SOLO-1 at ESMO 2020 impact your recommendations?

Is MDS/AML risk increased with longer duration of therapy? Does your approach differ for patients who are BRCA+/HRD vs wild type/HRP?

Primary R0 debulking in 2018 followed by Carbo/Tax for 6 cycles, and single agent Bevacizumab followed by Letrozole, now again with NGR

No hormonal or somatic tumor testing has been obtained.

Path significant for micropapillary features and micro-invasion

Given recent approval of niraparib (Zejula) for the maintenance treatment of adult patients with advanced epithelial ovarian, fallopian tube, or prima...

Is there a role for continuing beyond 24 months?

Does your strategy differ if the patient is on maintenance PARP inhibitor, bevacizumab, both, or neither? 

Would you change your approach based on platinum sensitivity or other factors?

Patient is s/p USO only, would you take her back to remove the contralateral ovary?

Patient is currently cycle 5/6 of carboplatin/taxol and tolerating well, has received no bevacizumab.

Pathology with infiltrative subtype

EP vs C/T? Would you perform additional imaging, ie. PET Dotatate to evaluate for metastatic disease?

Patient has been treated with carbo/taxol, hormonal therapies, and trametinib to date.

Based on recent PAOLA-1

How (if at all) does this change your counseling and willingness to add bevacizumab to a regimen?

Patient with remote history of hysterectomy for benign disease

https://ascopubs.org/doi/abs/10.1200/JCO.2020.38.15_suppl.6000 

 Specifically, if they are to be treated similar to GI cancers that receive FOLFOX/EPIC

SOLO1 trial studied stage 3/4 patients.

How does fertility preservation factor into your decision making?

Or do you wait for platinum resistance?

Is it reasonable to use single agent carboplatin for elderly patients?

Would you approach this situation as synchronous primaries (eg. FIGO IA in both) or as a locally advanced endometrial cancer (FIGO IIIA)? What adjuva...

For example, would you consider adjuvant chemotherapy alone to be sufficient in a patient with an isolated pelvic recurrence and positive margin after...