Gynecologic Cancers: Case 2 - Episode 1
Dr. Monk says this patient is an ideal candidate for ‘palliative chemotherapy.’ The regimen should include a palatinate if the patient can tolerate it, along with a second agent. A Japanese study suggested that cisplatin and carboplatin are noninferior with regards to PFS and OS in combination with paclitaxel. The GOG 204 study suggested that platinum plus paclitaxel had the longest OS compared with other platinum doublets (gemcitabine, vinorelbine, and topotecan). My preferred regimen would be carboplatin (area under the curve [AUC] of 5) and paclitaxel at 175 mg/m2 over 3 hours, being careful to monitor for thrombocytopenia, given her history of pelvic radiation. When bevacizumab is added, a median improvement in OS of 4 months and a 10% increase in objective response rate (ORR) to 45 can be expected, according to GOG 240.
CASE 2: Cervical Cancer
Stephanie M. is a 48-year-old Caucasian mother of 2 children who works as a dental hygienist.
She presented to her PCP in May 2012 with vaginal discharge and pain during intercourse. Prior medical history was notable for smoking (quit 3 years ago) and well-controlled hypertension. Patient had completed only sporadic cervical screening for the past 10 years.
In September 2014, she presented with worsening abdominal pain and fatigue. CT scan showed diffuse pelvic and aortic adenopathy consistent with disease recurrence. Her renal and hepatic function were adequate.