Gynecologic Cancers: Case 2 - Episode 1

Bradley J. Monk, MD, FACOG, FACS: Key Parameters to Determine Therapy

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.

  • Subsequent Pap smear showed the presence of squamous intraepithelial lesions and HPV-16 positivity
  • She was referred to oncologist for further evaluation. Ultrasound and colposcopy showed the presence of a 3.0-cm lesion in cervix with extension into the vagina. Patient was diagnosed with squamous cell carcinoma FIGO stage 1B1
  • Patient underwent radical hysterectomy with pelvic lymphadenectomy, with 3 positive pelvic nodes
  • She received pelvic radiotherapy with concurrent weekly cisplatin
  • Patient remained disease free for approximately 2 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.

  • Patient received treatment with cisplatin/paclitaxel for metastatic disease
  • After 3 cycles, patient presents with worsening pain and CT evidence of disease progression