In a patient with squamous vulvar cancer previously treated with cisplatin and radiotherapy and now with widely metastatic recurrence, would you initiate treatment with chemotherapy or consider immunotherapy?  

This is a difficult case, and the literature on systemic treatment options in metastatic vulvar cancer is sparse. I would check for PDL1, MMR as you have done. In addition, I would also test for NTRK gene fusion. A next general sequencing panel such as CARIS or Foundation One is useful in these sett...

I would wait for the CPS score. If >1, then immunotherapy.  If not - carbo/taxol/bev.