Ovarian Cancer&nbsp;&nbsp;&nbsp;

In the setting of platinum resistant ovarian cancer, do you consider repeat use of bevacizumab with subsequent lines of chemotherapy following prior treatment with chemotherapy + bevacizumab with bevacizumab maintenance?

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

What staging procedures do you include for clinically apparent stage I or II ovarian cancer?

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

What is your preferred adjuvant chemotherapy regimen after a completely resected stage IIIB Granulosa Cell tumor of the ovary?

How do you approach interval cytoreductive surgery in patients with epithelial ovarian cancer requiring 6 or more cycles of neoadjuvant chemotherapy?

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 consider HIPEC in a known BRCA+ IIIC ovarian cancer patient undergoing interval debulking surgery if the patient is known to desire PARPi maintenance following completion of chemotherapy?

What are your top takeaways from SGO 2022?

10 Answers available

What is your preferred approach to adjuvant treatment for stage IC grade 1 endometrioid ovarian adenocarcinoma?

If a premenopausal woman underwent a hysterectomy with unilateral SO with final pathology demonstrating an intact mucinous borderline tumor with negative washings, would you take her back for surgical staging?

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

Would you alter neoadjuvant chemotherapy regimen for a high grade small cell neuroendocrine carcinoma of the ovary if she has already received cycle 1 of carbo/taxol?

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

What chemotherapy would you consider to treat platinum resistant high grade serous ovarian cancer in patients with a low grade MDS from prior platinum/PARPi?

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

With the recent published results of DESKTOP III, do you intend to change your practice of performing secondary cytoreductive surgery for recurrent, platinum-sensitive ovarian cancer?

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

Do you offer PARP inhibitor maintenance retreatment of platinum-sensitive, relapsed, high grade serous ovarian cancer in patients who had a complete response to their most recent platinum-based chemo?

Front-line PARP inhibitor maintenance therapy discontinued without progression.

5 Answers available

What is your approach to adjuvant treatment for stage IA small cell carcinoma of the ovary, hypercalcemic type, after fertility sparing surgical staging?

What is your strategy to help prevent paclitaxel-related neuropathy?

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

When, if ever, would you recommend risk reducing BSO in patients with moderate penetrance breast cancer germline mutations?

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

How do you counsel premenopausal women with BRCA1 or BRCA2 mutations on the need for bilateral oopherectomy?

How many cycles of BEP would you treat an immature teratoma of the ovary?

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

Would concurrent endocrine therapy and PARPi maintenance be safe and appropriate after surgical treatment/adjuvant chemotherapy for a patient with BRCA1 mutated synchronous early stage HR+ breast CA and Stage IIA Fallopian tube carcinoma?

Would you add a PARP inhibitor to bevacizumab maintenance for a patient with a high grade serous ovarian cancer with a germline BRCA2 variant of unknown significance and negative somatic testing?

How do you approach a metastatic juvenile granulosa cell tumor of the ovary in a premenopausal patient following a hysterectomy and USO with the remaining ovary in situ?

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...

Would you consider HIPEC in patients with advanced ovarian cancer undergoing primary cytoreductive surgery?

For instance, in patients that have not had neoadjuvant chemotherapy

What chemotherapy would you utilize for a metastatic dysgerminoma diagnosed in the second trimester of pregnancy?

Would SBRT be recommended for a non-surgical isolated para-aortic recurrence in the setting of metastatic papillary serous ovarian cancer residual disease after systemic therapy?

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.

How would you treat an advanced stage small-cell carcinoma of the ovary, hypercalcemic type? (SCCOHT)?

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

How would you manage a patient with history of stage IIIC HGSOC after secondary cytoreduction of isolated inguinal node recurrence 12 years after primary treatment?

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

Would you recommend PARP inhibitor maintenance for a BRCA wild-type, HRD+ advanced ovarian cancer?

How long would you continue second line maintenance PARP inhibitor in a patient with recurrent stage IV BRCA+ ovarian cancer who had CR and remains NED?

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

6 Answers available

How do you approach staging for a patient with adult granulosa cell tumor, grossly confined to one ovary, and desiring a fertility sparing procedure?

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

How would you manage a patient with recurrent granulosa tumor following secondary, R0 cytoreduction, and negative inhibins postoperatively?

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

Is there any role for PARPi maintenance in BRCA-/HRD- patients after response to front line chemotherapy +/- bevacizumab?

What factors impact your decision to include bevacizumab with primary chemotherapy for patients with BRCA+ or HRD+ ovarian cancer?

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

4 Answers available

What is your current practice for obtaining mutation status for a patient with newly diagnosed ovarian cancer?

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

Which PARP inhibitor do you recommend for maintenance therapy in BRCA+ ovarian cancer after primary chemotherapy and why?

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

When would you continue bevacizumab versus using PARPi alone for maintenance therapy in BRCA+ or HRD+ ovarian cancer after response to primary platinum + bevacizumab?

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

How do you advise patients on duration of first line maintenance PARPi and the potential risk of MDS or AML?

Is MDS/AML risk increased with longer duration of therapy?

How would you manage a patient with recurrent stage IIIC granulosa tumor following secondary, R0 cytoreduction?

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

Would you consider IP chemotherapy in a BRCA positive advanced ovarian cancer patient after upfront ovarian debulking surgery to no gross residual?

What is your approach to adjuvant therapy for stage IC low grade serous ovarian cancer s/p full staging with R0 resection?

No hormonal or somatic tumor testing has been obtained.

How would you counsel a young patient regarding HRT after BSO for Stage IIIA1 serous borderline tumor?

Path significant for micropapillary features and micro-invasion

Would you consider retrying a platinum based chemotherapy agent in a platinum resistant ovarian cancer patient?

In what scenario would you prefer weekly vs every 3 week carboplatin/paclitaxel for high grade serous ovarian cancer?

How are you counseling HR-proficient ovarian cancer patients about front line PARP inhibitor maintenance?

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

When do you discontinue PARP inhibitor maintenance after complete response to first line chemotherapy in a BRCA+ patient?

Is there a role for continuing beyond 24 months?

What is your preferred adjuvant regimen for an optimally cytoreduced, stage III low grade serous ovarian carcinoma?

How do you incorporate surveillance imaging for patients with ovarian cancer on maintenance PARP?

Do you repeat somatic tumor testing for ovarian cancer patients after recurrence?

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

How would a focus of anaplastic carcinoma change your approach to adjuvant therapy for a premenopausal patient with stage IC mucinous borderline tumor of the ovary?

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

For an optimally cytoreduced, stage III ovarian carcinosarcoma, would you offer bevacizumab maintenance after completion of adjuvant carboplatin/taxol?

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

What adjuvant therapy would you recommend for FIGO stage IC2 (or greater) mucinous tumor of the ovary?

Pathology with infiltrative subtype

What chemotherapy would you recommend for a stage IC3 large cell neuroendocrine tumor of the ovary?

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

What treatment options would you consider for a metastatic low grade serous ovarian carcinoma that transforms to high grade?

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

Are you offering PARP inhibitor alone or both PARP inhibitor and bevacizumab maintenance for HRD+ ovarian cancer patients after upfront treatment?

Based on recent PAOLA-1

What pre-treatment findings on CT scan (if any) influence your concern for GI perforation risk with bevacizumab use in ovarian cancer patients?

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

How do you incorporate diagnostic laparoscopy for interval debulking surgery?

Would you consider adjuvant chemotherapy in a young patient with stage IC1 Sertoli-Leydig cell tumor, moderately differentiated, with heterologous (rhabdosarcomatous) component and retiform elements?

What adjuvant therapy would you offer for an incidental endometrioid adenocarcinoma of the ovary noted on LSO, who has only a 3mm residual disease on peritoneal biopsy from completion staging?

How would you approach post op management of a patient s/p BSO for cystic pelvic mass with fallopian STIC lesion on final pathology?

Patient with remote history of hysterectomy for benign disease

When is it too late to start PARP manitenance after adjuvant chemotherapy in BRCA mutated ovarian cancer who had a delay in completing genetic testing?

Is there a role for minimally invasive surgery in patients undergoing an interval cytoreductive surgery?

Do you alter treatment in high grade serous ovarian cancer patients receiving neoadjuvant chemotherapy with stable disease after 3 cycles?

Should a bowel prep be considered when performing an ovarian cancer debulking and/or bowel resection?

Do you obtain somatic genomic testing for ovarian cancer patients that test negative for gBRCA mutation?

In light of DESKTOP III, how will you approach secondary debulking for platinum sensitive epithelial ovarian cancer patients?

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

What adjuvant therapy would you recommend for a Stage IIIC low grade serous ovarian cancer following following fertility sparing surgery?

Should our selection for neoadjuvant chemotherapy in ovarian cancer patients change in light of COVID-19?

Do you consider MSI testing for nonserous ovarian cancer?

Are maintenance therapies for ovarian cancer being held at your institution due to COVID-19?

Is there a role for IP chemotherapy in advanced mucinous ovarian cancers following complete cytoreductive surgery?

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

What adjuvant chemotherapy is preferred in primary ovarian mucinous adenocarcinoma of intestinal type?

Would you consider radiation therapy for ovarian dysgerminoma with residual lymphadenopathy after chemotherapy?

Do you routinely offer PARP inhibitor maintenance therapy to germline BRCA1/2+, FIGO stage II serous ovarian carcinoma patients after adjuvant chemotherapy?

SOLO1 trial studied stage 3/4 patients.

What is optimal timing or sequencing of therapy for patients with synchronous locally advanced triple negative breast cancer and ovarian cancer with peritoneal carcinomatosis?

Do you recommend frontline bevacizumab with carbo/taxol in patients with advanced epithelial ovarian and BRCA mutation who will be receiving olaparib maintenance?

In light of GOG-252, are there any situations where IP chemotherapy would be preferable following debulking of advanced epithelial ovarian cancer?

When do you choose dose-dense chemotherapy v. q3 week therapy in advanced epithelial ovarian cancer?

How do you decide when to offer post-operative adjuvant treatment for a stage IC1 ovarian granulosa cell tumor?

How does fertility preservation factor into your decision making?

Would you consider initiation of bevacizumab maintenance in a patient with primary ovarian cancer after optimal debulking surgery and standard carbo/taxol if they did not receive bevacizumab beginning with the carbo/taxol?

When do you refer a patient with metastatic ovarian cancer for upfront debulking v. neoadjuvant chemotherapy?

What are the preferred treatment options for platinum resistant clear cell ovarian carcinoma?

Do you recommend bevacizumab in platinum sensitive recurrences of epithelial ovarian cancer?

Or do you wait for platinum resistance?

What is your approach to an optimally debulked patient with Stage Ia FIGO gr 3 serous carcinoma of the ovary?

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

How would you manage a patient with low-volume non-invasive endometrioid carcinoma that is found in both the endometrium and ovary (pN0)?

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

In what situations do you consider adjuvant radiation for ovarian cancer?

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