Trial By Design
Presented in tandem at SGO 2023, these trials established immunotherapy as a new standard of care for advanced or recurrent endometrial cancer
If an itis develops while on pembrolizumab, these agents are considered the gold standard to control a raging immune system
Steroids
Although it offers no therapeutic benefit to clear active infections or treat existing cervical dysplasia, CDC guidelines still recommend administering this to eligible patients with an abnormal Pap or positive high-risk HPV result to protect against other strains they have not yet acquired
What is a gardasil vaccine
Two weeks after radical vulvectomy, a patient reports feeling a “pop.” On examination, there is superficial skin separation with intact deeper layers, no erythema, minimal granulation tissue, and no purulent drainage. This is the appropriate management.
What are reassurance and wound-care education?
After a prolonged period of negative trials using immunotherapy in ovarian cancer, this trial established what new regimen for platinum resistant ovarian cancer? (Trial name and regimen please)
Keynote B96 - paclitaxel with pembrolizumab +/- bevacizumab
Pneumonitis
Following surgical menopause, chemotherapy-induced ovarian failure, or endocrine therapy, many gynecologic cancer survivors experience this common genitourinary syndrome characterized by vaginal dryness, irritation, dyspareunia, and recurrent urinary symptoms.
What is vaginal atrophy
A patient presents 48 hours after laparoscopic tumor debulking, TLH-BSO, omentectomy, pelvic and para-aortic lymphadenectomy, and extensive lysis of adhesions. Her creatinine has risen from 0.78 preoperatively to 3.12. This injury should be suspected, and ultrasound may reveal this finding.
What is a ureteral injury, with unilateral hydronephrosis on ultrasound?
Avutometinib and defactinib combination therapy for low-grade serous ovarian cancer is FDA approved in the presence of these mutations
KRAS mutations
I didn't know trametinib would make me feel like a teenager again - what can you give me to manage my breakouts?!
Topical clindamycin with oral doxycycline
Often performed for malignant bowel obstruction or severe ascites in advanced ovarian cancer, this bedside or interventional radiology procedure uses a small tube to drain fluid or decompress the stomach for symptomatic relief without curative intent.
What is a venting gastrostomy
A patient with platinum-resistant ovarian cancer has a persistent small bowel obstruction and has elected comfort-focused care. She has significant vomiting and does not want a nasogastric tube for ongoing decompression. This palliative procedure can provide longer-term gastric decompression and improve comfort.
What is a venting gastrostomy tube (G-tube)?
This trial combines a glucocoticoid receptor antagonist in combination with a special taxane, so avoid all steroid use please
ROSELLA - relacorilant with nab-paclitaxel
Alopecia is reported at 20-30% in trials use this class of targeted therapeutic agents?
Anti-body drug conjugates (ADCs)
To prevent radiation-induced vaginal stenosis and shortening following pelvic radiotherapy or brachytherapy, clinicians routinely prescribe this progressive set of tube-shaped medical devices to maintain tissue elasticity and vaginal caliber.
What are vaginal dilators
During sentinel lymph node dissection for endometrial cancer staging, injury to this nerve can paralyze the thigh adductors, making it difficult to cross the legs or ride a horse.
What is the obturator nerve?
Speaking of low grade ovarian cancer, this trial recently showcased that chemotherapy followed by letrozole maintenance should be standard of care, unless you have no gross residual after surgery
You're old so your eye sight isn't great - but let me add these therapies to make sure we tip that vision right over the edge. (name at least 2 of us)
Mirvetuximab, tisotumab, trametinib, avutometinib/defactinib
Approved by the FDA as the first neurokinin 3 (NK3) receptor antagonist for non-hormonal management, this oral medication targets temperature-regulating neurons in the hypothalamus to reduce moderate-to-severe hot flashes.
What is veozah or fezolinetant
A patient with locally advanced vaginal cancer has sigmoid colon involvement confirmed on MRI and colonoscopy. She will receive upfront chemotherapy with possible radiation afterward. To reduce the risk of obstructive symptoms or fecal contamination from developement of a vaginocolonic fistula, this palliative surgical procedure could be considered.
What is a diverting colostomy?