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Gynecologic Cancers
Insights From an Educational Program on the Evolving Treatment Landscape for Gynecologic Cancers

Released: September 02, 2025

Ebony R. Hoskins
Ebony R. Hoskins, MD, FACOG
Kathleen N. Moore
Kathleen N. Moore, MD, MS, FASCO
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Key Takeaways
  • Ovarian cancer remains a major cause of mortality with high recurrence rates and racial disparities, underscoring the need for equitable access to biomarker testing and clinical trial participation.
  • Advances such as PARP inhibitors, immune checkpoint inhibitors, and antibody–drug conjugates are reshaping the treatment of gynecologic cancers.
  • Cervical cancer care is evolving with earlier integration of immunotherapy-based regimens (chemoradiation plus pembrolizumab) based on KEYNOTE-A18 and availability of antibody drug conjugates in the recurrent setting.

In this commentary, Ebony R. Hoskin, MD, FACOG, and Kathleen N. Moore, MD, MS, FASCO, discuss the evolving treatment landscape for patients with gynecologic cancers (endometrial, ovarian, and cervical). The experts also share their answers to frequently asked questions from an audience of healthcare professionals (HCPs) who participated in live small group workshops across the United States.

Expert Insight of Notable Outcomes Results From the Educational Program

Ebony R. Hoskin, MD, FACOG:
Ovarian cancer remains a leading cause of death from gynecologic cancer among women. Overall, the 5-year survival for women with ovarian cancer is approximately 50%. Disease recurrence is quite common (90%-95%) among women with stage IV disease at diagnosis. Moreover, Black women are at a higher risk of being diagnosed with more advanced disease and are more likely to die from their ovarian cancer diagnosis compared to White women. Available data suggest clinical trial participation can help mitigate disparities in survival outcomes for Black women with ovarian cancer. Learners who took part in our program indicated that they would increase their efforts to help promote clinical trials as part of routine care.

Ongoing challenges discussed in the program included persistent psychosocial issues such as:

  • Lack of support (including at home and at many care sites)
  • Inability for some patients to travel long distances (ie, living in rural areas like Wyoming, Montana, and Maine)
  • Language barriers
  • Insurance coverage (ie, women with Medicare or Medicaid undergo less germline or somatic testing than those with private insurance)

These issues can significantly affect adherence to therapy and access to clinical trials.

Kathleen N. Moore, MD, MS, FASCO:
I also wanted to add that there are some epidemiology data looking at racial and ethnic differences across the different histologies of gynecologic cancer that suggest Black women may present with biomarkers that portend higher-risk disease. In addition, we found during the workshop series that fewer than 50% of participants choose to check for actionable biomarkers such as BRCA or HRD status before initiating therapy for ovarian cancer. I know it would be ideal to check for those biomarkers prior to start of therapy, but I also recognize that often we may start a chemotherapy backbone first because it does not necessarily change, at least at this time, after we obtain results for those biomarkers. I agree that checking for germline BRCA is essential if we are considering a PARP inhibitor. HRD results will further inform the decision about whether a PARP inhibitor is indicated.

As part of the program, we helped put together a summary list of the latest guideline recommendations, including for biomarker testing, as well as a summary of changes to the approved indications for PARP inhibitors in patients with ovarian cancer. The program also included a patient communication checklist resource, which is available online and has input from a focus group led by SmartPatients™, a nonprofit patient advocacy group. I encourage HCPs to download a copy and use it to help talk with and educate their patients about treatment goals and treatment options, and for patients to provide feedback on practical personal concerns and activities of daily living to their care team.

Growing List of Novel Therapies in Gynecologic Cancers

Ebony R. Hoskin, MD, FACOG:
Educating patients about their treatment options has never been more important. We have been fortunate in our field with new options available for patients whose disease is classified as platinum-refractory ovarian cancer. In ovarian cancer, the novel antibody–drug conjugate (ADC) mirvetuximab soravtansine was approved based on data from the phase III MIRASOL study in patients with folate receptor alpha–positive platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer who have received 1-3 prior systemic treatment regimens.

In endometrial cancer, we have also had several approvals including for various anti–PD-1 or anti–PD-L1 immunotherapy options given in either front-line metastatic settings with chemotherapy or in the second-line recurrent setting either as monotherapy or in combination with lenvatinib based on biomarker status. The various immunotherapy options have in turn generated a continuous need for education on which agent is approved in what setting and whether there is a need for a biomarker such as DNA mismatch repair deficient (MMRd) status or microsatellite instability-high (MSI-H) in endometrial cancer. We observed this need with the results from polling questions at the workshops series. At baseline, only 16% of respondents indicated that they were confident or very confident in applying the current guidelines and biomarker testing recommendations to develop personalized treatment plans for patients with gynecologic cancer. Clearly this is an area in need of ongoing education and reinforcement.

Kathleen N. Moore, MD, MS, FASCO:
Because of the success of immune checkpoint inhibitors (ICIs) in patients with relapsed/recurrent and newly diagnosed advanced/metastatic endometrial cancer, there was a strong rationale for evaluating ICIs earlier in the disease course. More recently, we have seen data presented for the phase III KEYNOTE-B21 trial of adjuvant chemotherapy with radiotherapy and pembrolizumab in patients with newly diagnosed endometrial cancer or carcinosarcoma with no residual disease after curative intent surgery but at high risk of disease recurrence. The primary endpoint of disease-free survival in the intention-to treat-population did not show a statistical difference with the median not reached in either group (HR: 1.02; P =.570). However, looking at disease-free survival in the patients with MMRd status there was a trend in favor of the arm containing pembrolizumab compared with the arm containing placebo (HR: 0.31).

Ebony R. Hoskin, MD, FACOG:
For patients with cervical cancer, we also discussed new data for the use of ICIs in the first-line setting (platinum-based chemotherapy plus pembrolizumab with or without bevacizumab) and in the second-line setting (pembrolizumab if PD-L1 positive/MSI-H/MMRd/tumor mutational burden-high; and nivolumab for PD-L1 positive) as reminders about the standards of care. We also covered the significant disparities regarding cervical cancer development and the underutilization of human papillomavirus (HPV) vaccination. We were pleased to see that as a result of the educational workshops, a key practice change from learners was that they were going to provide education on HPV vaccination and educate patients about the importance of postmenopausal bleeding evaluation for early detection of this disease.

Frequently Asked Questions 

How do you approach treatment decisions when BRCA/HRD status is unknown at diagnosis of high-grade serous carcinoma? 

Ebony R. Hoskin, MD, FACOG:
In those situations where I do not know BRCA or HRD status at diagnosis, I strongly encourage patients to undergo genomic/germline testing. Often, patients do not want to know. They may be concerned about insurance coverage and for one reason or another do not pursue testing. In that scenario, we have to honor their choice. These are cases where I may offer observation following surgery. I may also suggest somatic testing on the tumor tissue if I think that might help inform my treatment decision.

In your experience, how responsive are ocular toxicities from mirvetuximab soravtansine to treatment holds and/or dose reduction?

Ebony R. Hoskin, MD, FACOG:
I have not had much experience with this. One of my patients who began experiencing ocular toxicity (blurred vision) while receiving mirvetuximab soravtansine opted for full discontinuation. I think it is important that we educate our patients about what to expect and to illustrate that these adverse events can be reversible. Despite all of the education, some patients express concern that they will lose their eyesight. I think education is best to reassure them but we must respect patient choice to discontinue.

Kathleen N. Moore, MD, MS, FASCO:
I have treated more than 100 patients with mirvetuximab soravtansine, and most of them report feeling better on this ADC than on chemotherapy. There is no hair loss, minimal effect on blood counts (ideal for platinum-resistant patients with low blood counts), and far less neuropathy than with paclitaxel. However, mirvetuximab soravtansine and certain other ADCs are associated with ocular toxicity, and patients need to be made aware of this risk. This usually occurs after cycle 2 and can include vision disturbances, dry eyes, and blurry vision, but only rarely eye pain. Ocular toxicity can be kept at a low grade with lubricating eyedrops, steroid eyedrops, and occasionally dose modification of mirvetuximab soravtansine. In trials to date, and in my clinical experience, fewer than 1% of patients discontinue mirvetuximab soravtansine because of ocular toxicity.

In a patient with uterine cancer with a BRCA mutation what should we do differently?

Ebony R. Hoskin, MD, FACOG:
If as part of uterine cancer management we also surgically removed the ovaries and fallopian tubes, then we have effectively reduced the risk for ovarian cancer in the setting of uterine cancer. In this scenario, with BRCA mutation in the setting of resected uterine cancer, I do think it would be appropriate for the patient to be referred to genetic counseling regarding ovarian cancer. What we might do at our center instead is refer them for pancreatic cancer evaluation by a gastroenterologist or to a breast oncology expert for breast cancer screening.

Which combination of ICI plus chemotherapy do you prefer in patients with advanced endometrial cancer? 

Ebony R. Hoskin, MD, FACOG:
This is a question that comes up often in many of our programs. Where I practice, we use pembrolizumab plus chemotherapy for advanced endometrial cancer and MMR proficient status. I may use dostarlimab in patients with advanced carcinosarcoma—which is a population included in the phase III RUBY trial evaluating the combination of standard of care platinum-based chemotherapy with or without dostarlimab followed by dostarlimab or placebo maintenance for 3 years in patients with primary advanced/recurrent stage III/IV endometrial cancer. In that study, addition of dostarlimab improved progression-free survival outcomes in patients with MMRd status. This included patients with carcinosarcoma, which was the histologic subtype identified in 17.8% of the total population of that study. In contrast to RUBY, patients with carcinosarcoma were excluded from the phase III NRG GY018 study evaluating addition of either pembrolizumab or placebo to standard carboplatin/paclitaxel, followed by maintenance with pembrolizumab or placebo.

Kathleen N. Moore, MD, MS, FASCO:
At our center we use pembrolizumab based on a central formulary and similar to your site, we use dostarlimab for patients who have carcinosarcoma histology. I do not think there is a notable difference regarding efficacy or safety for either agent. So, I would say use of either agent would be fine if formulary was not a consideration.

When do you use the INTERLACE regimen in patients with cervical cancer?

Kathleen N. Moore, MD, MS, FASCO:
As a reminder, the international, multicenter phase III INTERLACE trial evaluated induction chemotherapy with weekly paclitaxel and carboplatin for 6 weeks followed by chemoradiotherapy (CRT) vs CRT alone in patients with newly diagnosed FIGO 2008 stage IB1N+, IB2, II, IIIB, IVA squamous, adenocarcinoma, and adenosquamous cervical cancer. We may use the INTERLACE regimen in patients with large stage I disease, particularly if they are going to receive chemotherapy and radiotherapy but they do not have positive nodes. We mainly use the INTERLACE approach to reduce the tumor size, then we will start chemotherapy and radiotherapy. For smaller stage II disease, we might use it as well and for any tumor that is node-positive. For the combination of bulkier tumors, we are using the KEYNOTE-A18 regimen. We had not used neoadjuvant treatment before, but we are doing a fair amount of it now and we follow the label.

Of the available treatment options for cervical cancer, is there a specific treatment that limits adverse impact on quality of life for the patient?

Ebony R. Hoskin, MD, FACOG:
Currently, no treatment clearly limits quality-of-life impact. In the frontline setting, and potentially curative settings, getting through the chemotherapy and the radiation concurrently and the side effects that result from those treatments can be challenging. I try to reassure patients that for a finite amount of time they will have to go through this tough treatment, but that our goal is to go for limited treatment and potentially cure. In the recurrent setting, all treatments are associated with adverse effects. We are always looking for the ones that strike a balance between efficacy and good quality of life.

How do you handle vaccine counseling for HPV in older or high risk women who are previously unvaccinated?

Ebony R. Hoskin, MD, FACOG:
In patients 50 years of age or older, I would not recommend it because we just do not have the data in that patient population. However, for someone 45 years of age or younger who have not previously received it, I strongly encourage them to get vaccinated. At the workshops, we provided examples and current guidelines on who and when to get the HPV vaccination. I was 40 years old myself when I got vaccinated.

Your Thoughts
What are your thoughts on the evolving treatment landscape of patients with endometrial, ovarian, and cervical cancer? Answer the polling question and leave a comment for us. Visit the program page, watch an on-demand webcast, download the program slides, and access a downloadable patient-HCP resource on this topic.

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How often do you discuss clinical trials as potential treatment options with underrepresented patients of color with an advanced ovarian cancer diagnosis? 

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