Entrectinib use in a platinum-refractory mucinous ovarian cancer harboring a NTRK3 gene fusion.

Ovarian cancer is difficult to treat, and the mucinous epithelial subtype has a particularly poor response to traditional chemotherapy regimens. Entrectinib is a tumor-agnostic tyrosine kinase inhibitor with limited data regarding its use in ovarian cancers, though it demonstrates significant tumor response and patient tolerability in other settings. Here we outline what we believe to be the first case in which Entrectinib was successfully utilized to treat a patient with mucinous ovarian cancer. A 51-year-old woman with stage IVB mucinous ovarian cancer possessing a KANK1-NTRK3 gene fusion experienced tumor progression and clinical deterioration with conventional chemotherapeutics. Upon initiation of Entrectinib treatment she experienced rapid clinical improvement, with significant partial response and sustained decrease in tumor markers.

Doubling down on the future of gynecologic oncology: The SGO future of the profession summit report.

The original vision of the field of gynecologic oncology was to establish a multidisciplinary approach to the management of patients with gynecologic cancers. Fifty years later, scientific advances have markedly changed the overall practice of gynecologic oncology, but the profession continues to struggle to define its value-financial and otherwise. These issues were examined in full at the Society of Gynecologic Oncology (SGO) Future of the Profession Summit and the purpose of this document is to summarize the discussion, share the group's perceived strengths, weaknesses, opportunities, and threats (SWOT) for gynecologic oncologists, further educate members and others within the patient care team about the unique role of gynecologic oncologists, and plan future steps in the short- and long- term to preserve the subspecialty's critical mission of providing comprehensive, longitudinal care for people with gynecologic cancers.

Just Say Yes? A Cluster Analytic Approach to Evaluating College Students' Understandings of Affirmative Consent.

Affirmative consent policies on college campuses establish more stringent standards for inferring consent to sex. Although these policies often permit nonverbal communication of consent, they rarely outline finer-grained distinctions about which specific behaviors can stand-in for verbal affirmation. It thus remains possible that students hold different understandings of this policy vis-à-vis the nonverbals used to convey and infer consent, which could undermine the purported utility of affirmative consent initiatives. We presently sampled 442 college undergraduates and asked them to rate whether specific behaviors often present during sexual interaction constitute affirmative indicators of consent. We hypothesized that students would separate into one of three groups depending on how restrictive (e.g., verbal communication only), inclusive (e.g., verbal and clear nonverbals) or potentially non-diagnostic (e.g., sexual arousal, passivity) their behavioral definitions were of affirmative consent. Using cluster analysis, we ultimately identified two groups adhering to a restrictive versus more inclusive operationalization. The former cluster understood affirmative consent as comprising verbal affirmation with variable endorsements of specific nonverbals, whereas the latter consistently endorsed a broader set of nonverbals along with variable ascription to behaviors that do not strongly imply consent. Students in the more inclusive group were more sexually experienced, less likely to use condoms, and viewed casual sex more favorably; as well as were likelier to have received sexual assault education from their parents before and during college, as well as from social media. These findings suggest that subgroups of college students construe affirmative consent policy differently and that these understandings may relate broadly to an individual's sexual experiences, attitudes, and/or education.

OVARIO phase II trial of combination niraparib plus bevacizumab maintenance therapy in advanced ovarian cancer following first-line platinum-based chemotherapy with bevacizumab.

OBJECTIVE: To assess safety and efficacy of niraparib + bevacizumab as a first-line maintenance therapy for patients with newly diagnosed advanced ovarian cancer. METHODS: This multicenter, phase II, single-arm, open-label study enrolled adult patients with stage IIIB to IV ovarian, fallopian tube, or primary peritoneal cancer (NCT03326193). Patients were required to have an attempt at debulking surgery and have a complete response, partial response, or no evidence of disease following first-line, platinum-based chemotherapy with ≥3 cycles of bevacizumab. The primary endpoint was the progression-free survival (PFS) rate at 18 months. Secondary endpoints included PFS, overall survival, and safety. RESULTS: Among the 105 evaluable patients, the PFS rate at 18 months was 62% (95% CI 52-71%) in the overall population and 76% (95% CI 61-87) in the homologous recombination deficient (HRd), 47% (95% CI 31-64%) in the HR proficient (HRp), and 56% (95% CI 31-79%) in the HR not determined (HRnd) subgroups (December 24, 2020, cutoff). After a median follow-up time of 28.7 months (IQR, 23.9-32.5 months), median PFS was 19.6 months (95% CI 16.5-25.1) in the overall population (N = 105) and 28.3 months (95% CI 19.9-NE), 14.2 months (95% CI 8.6-16.8), and 12.1 months (95% CI 8.0-NE) in the HRd, HRp, and HRnd subgroups, respectively (June 16, 2021, cutoff). The most common any-grade treatment-related adverse events (related to niraparib and/or bevacizumab) were thrombocytopenia (74/105), fatigue (60/105), and anemia (55/105; December 24, 2020, cutoff). CONCLUSION: Niraparib + bevacizumab first-line maintenance therapy displayed promising PFS results. Safety was consistent with the known safety profiles of niraparib and bevacizumab as monotherapy.

"Every time I tell my story I learn something new": Voice and inclusion in research with Black women with histories of substance use and incarceration.

While current ethical procedures aim to minimize risks to imprisoned individuals, there is heightened awareness of the need to protect those who participate in research post-incarceration while under community-based supervision. Formerly incarcerated women, in particular, face myriad challenges to community reintegration which also make them vulnerable participants in research. As such, this study explores how 28 formerly incarcerated Black women experience the qualitative research process. Findings revealed that women engaged in research because these contexts were viewed as therapeutic spaces for raising awareness that can help others. Moreover, the interview process allowed women to share their pasts in ways that promote their recovery from addiction. Participants also reported risks of emotional distress and fears regarding researcher stigma. The implications for trauma-informed interviewing practices underscore the need for greater considerations of the role of the researcher, research environment, and how they contribute to one's personal recovery.

Survival sex and trafficked women: The politics of re-presenting and speaking about others in anti-oppressive qualitative research.

Qualitative research grounded in a social constructionist epistemology troubles the assumption, integral in positivist research, that a researcher can be neutral and apolitical. In fact, many scholars are drawn to constructionist epistemologies because they situate the research process as a site of ontological resistance and social change. This essay explores the politics of voice and representation in anti-oppressive qualitative research. Using an example from one author's research on stigma management among formerly incarcerated women, and the particularly pernicious stigma women faced if they had engaged in sex work, we detail the benefits and pitfalls of either re-presenting research participants in their exact words or changing participants' words, a process we refer to as re-languaging. Drawing upon philosophical and social scientific scholarship on the "crisis of representation" in qualitative research and recent scholarship and news articles about human sex trafficking, we underscore the powerful political effects of language. We argue that researchers' choices about language are neither inherently liberatory nor oppressive, but they are always political. We call for a more reflexive scholarly dialog on voice in qualitative social work research and press scholars to explicitly engage the question of whom and what we represent when we claim to represent marginalized others.

A case of severe encephalitis while on PD-1 immunotherapy for recurrent clear cell ovarian cancer.

Recurrent clear cell ovarian carcinoma is a difficult to treat condition and early trial data has suggested a possible role for immune checkpoint inhibitors. Nivolumab is an anti-PD-1 immunotherapy that has been used in this setting. While immune related toxicity of these agents has been well described, the occurrence of immune specific neurotoxicity is thought to be rare. We present a case of severe encephalitis while on PD-1 immunotherapy for a recurrent ovarian clear cell cancer and we believe this to be the first such reported case associated with the use of PD-1 inhibitor monotherapy. In this case, a 64-year-old woman with persistent clear cell ovarian cancer on Nivolumab presented with a severe fever of unknown origin and delirium; initial imaging and diagnostic work-up suggested a neurological etiology, but with no clear source. We concluded that this was a severe case of immune related encephalitis, thought to be brought about by the anti-PD-1 immunotherapy which responded well to systemic corticosteroids and plasmapheresis and the patient able to make a full recovery. We present a summary of the case and its management as well as a review of the literature on the previously reported neurotoxicity's of PD-1 inhibitors.

The end of life costs for Medicare patients with advanced ovarian cancer.

OBJECTIVE: To describe the Medicare payments at the end of life for patients with advanced ovarian cancer, and assess factors responsible for payment variation METHODS: Using the linked Surveillance, Epidemiology and End Results (SEER)-Medicare database, we identified a cohort of women with stage III/IV epithelial ovarian cancer diagnosed between 1995 and 2007. We defined the end of life as the last 90days prior to death. Total medical costs were estimated from overall Medicare payments, and adjusted for geography and for inflation to the 2009 U.S. dollar. A generalized linear regression was performed to assess factors associated with variability in cost. RESULTS: Of 5509 patients, 78.9% died from ovarian cancer. In the 90days prior to death, 65.2% of patients had an inpatient admission, 53.7% received chemotherapy, 19.3% had a palliative procedure, and 62.5% had hospice services. The mean total payment per patient in the last 90days of life was $24,073 (range 0-$484,119) over the study time period. The mean cost of inpatient admissions was $14,529 (range 0-$483,932). On a multivariate analysis, costs at the end of life did not vary based on length of patient survival (p=0.77). Factors associated with significantly increased costs in the last 90days of life were medical comorbidity, chemotherapy, time spent as an inpatient, and admissions associated with emergency room visits. CONCLUSIONS: Reducing the prescription of chemotherapy and increasing the use of hospice services for ovarian cancer patients at the end of life will aid in lowering costs.

Conservative Management of Invasive Placentation: Two Cases with Different Surgical Approaches.

Background When placenta accreta complicates a delivery, the typical management is to perform a cesarean hysterectomy. Other management strategies, including leaving the placenta in situ, have been attempted and supported in some cases. This may allow for an interval hysterectomy, which can potentially decrease average blood loss and/or allow a minimally invasive approach to the hysterectomy. Cases We present two cases of women with invasive placentation managed conservatively with interval hysterectomy. One woman was managed with robotic-assisted laparoscopic surgery and the other with an open surgical approach. Conclusion These cases highlight the successful use of conservative management for invasive placentation in two stable patients and showcase the novel use of a robotic-assisted laparoscopic surgery for management of invasive placentation.

The Cost of Initial Care for Medicare Patients With Advanced Ovarian Cancer.

OBJECTIVES: In preparation for payment reform, we evaluated Medicare payments for the initial treatment of patients with advanced ovarian cancer and assessed factors responsible for variation. METHODS: Using the linked SEER-Medicare database, we identified a cohort of 9,491 women aged 65 years or older with stage III/IV epithelial ovarian cancer diagnosed between 1995 and 2007. Diagnostic and procedural codes specific to the care of ovarian cancer were used to estimate total medical costs for the treatment of ovarian cancer. Costs were adjusted for geography and for inflation to the 2009 US dollar. NCCN Guideline-consistent care was defined as surgery and 6 cycles of chemotherapy. A generalized linear regression was performed to assess factors associated with variability in cost. RESULTS: The mean total payment per patient in the initial treatment period was $65,908 (range of means, $30,745-$96,360). Increasing medical comorbidity, use of PET/CT, surgical complications, and readmissions were associated with increased costs. Treatment with NCCN Guideline-consistent surgery and chemotherapy had a mean annual cost of $85,987 compared with $89,149 for non-NCCN Guideline-consistent treatment with surgery and chemotherapy. The cost of surgery and chemotherapy that was not consistent with NCCN Guidelines was approximately $7,000 more than the cost of therapy that was consistent (P<.001) CONCLUSIONS: The financial burden of caring for patients with ovarian cancer is substantial. Treatment that is consistent with NCCN recommendations for treating advanced ovarian cancer, which is shown to have improved outcomes, is not associated with higher cost.

Ovarian cancer outcomes: Predictors of early death.

OBJECTIVE: To describe the outcomes and mortality in advanced ovarian cancer patients in a population-based cohort in the 90 days after diagnosis. METHODS: Using the linked Surveillance, Epidemiology and End Results (SEER)-Medicare database, we identified a cohort of women with stage III/IV epithelial ovarian cancer diagnosed between 1995 and 2007. A χ(2) test was used to assess demographic and clinical factors. Kaplan-Meier curves and Cox proportional hazards models were used to assess factors associated with variation in survival. RESULTS: Of the 9491 patients with stage III/IV ovarian cancer identified from the SEER/Medicare system, 4131 (43.6%) patients died in the first year after diagnosis. Of these, 2472 (26.0%) patients died in the first 90 days after diagnosis. Over the study period, the number of patients who died in the first 90 days after diagnosis slightly increased (p=0.053). Older age (>75 years of age), increased comorbidity, stage IV disease, lack of a visit with a gynecologic oncologist, and surgery were associated with an increase in 90-day mortality. Chemotherapy was associated with a reduction in 90-day mortality. CONCLUSIONS: Approximately 25% of patients with advanced ovarian cancer in our study period died within 90 days of diagnosis, and more than 40% died within the first year of diagnosis. In addition, a substantial proportion of patients did not receive any treatment. Further research into the characteristics of these patients should be performed to elucidate clinical areas for intervention to either prevent these poor outcomes or allocate appropriate resources to patients with extremely poor prognoses.

Extramarital Sex Among Vietnamese Married Men: Results of a Survey in Urban and Rural Areas of Northern and Southern Vietnam.

Research on extramarital sex (EMS) is commonly conducted from a perspective that implicitly understands this behavior as a violation of the marital relationship. In contrast, Vietnamese cultural norms have, at some points in history, condoned if not outright encouraged EMS in the name of preserving family lineage. Yet little is known about the prevalence of EMS among contemporary Vietnamese men and its association with marriage quality. This is a notable gap, given the enormous sociocultural and ideological shifts the country has experienced over the past several decades. Drawing upon a sample of 126 married men (Mean age = 45.56; SD = 10.52) surveyed in urban (Hanoi and Ho Chi Minh City) and rural areas (Ha Tay and Can Tho) in Vietnam, we examined the relationship between EMS and geographic region, demographic characteristics, sexual values, quality of marriage, and sexual satisfaction within marriage. Our results show that geographic location had a strong impact on EMS, while most marital relationship quality variables did not impact the odds of EMS for married men in Vietnam.

"I am tired but if I don't try to have sex, my wife will think I've been fooling around in the city": work, migration, and sex among Vietnamese migrant laborers.

Mostly operating from a risk and risk-reduction paradigm, existing research on migrants in Vietnam tends to conceptualize sex and risky sexual behaviors as isolated life domains. This study begins to develop a contextually rich understanding of migrants' sex lives by examining the relationships among sex, work, and the constant pendulum-like migrating movements of 23 Vietnamese married migrants in Hanoi and Ho Chi Minh City. Using data from in-depth interviews, it was found that most participants had no sex in the city; this was followed by visits to the home village, where they had sex with their spouses as often as possible to make up for the "long drought" in the city. Within this sexual schema, sex came secondary, and even peripherally, to migrants' working lives; thus, exhaustion from work was cited by migrants as the overwhelming factor leading to their sexual problems. This study suggests that migrants' intimate lives are more strongly linked to their working lives than has previously been recognized, and that their sexual behaviors should be viewed in tandem with the hardships of their working lives.

In full swing? How do pendulum migrant labourers in Vietnam adjust their sexual perspectives to their rural-urban lives?

Having emerged only recently due to fast urbanisation and globalisation, pendulum migrant labourers in Vietnam are economically, culturally and socially difficult to locate - though they are estimated to number in their millions. Defined by their frequent migration between village and city, pendulum migrant labourers occupy an extended period of liminality. Are they traditional villagers or liberal city people when it comes to sex? Does city life radically change their views on sexuality? Starting with the premise that living environments play a key role in structuring the practical and symbolic realities of sex, this paper explores how extended periods of circular migration between the village and city - living environments that differ markedly in terms of socioeconomic and cultural conditions - affect the sexual views and perspectives of Vietnamese pendulum migrant labourers. Analysis from in-depth interviews with 23 married pendulum migrant labourers revealed that even though they had been living the pendulum life for several years, they continued to identify themselves, sexually, as traditional villagers. Among labourers the link between sexuality and living environment was a matter of pragmatism - matching 'suitable' sexual behaviour to social, even if imagined, location - and of privilege or 'leagues' - matching behaviour and comportment to social pedigree.