The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Cervical Cancer provide diagnostic workup, staging, and various treatment recommendations for cervical cancer based on clinical and surgical staging. This selection from the NCCN Guidelines for cervical cancer specifically focuses on diagnosis and workup, principles of staging and surgery, and primary treatment recommendations for early-stage and advanced disease and provides a detailed overview of systemic therapy recommendations for cervical cancer.

Platinum-resistant ovarian cancer (PROC) remains a major clinical challenge, with limited effective treatment options and poor survival outcomes. Aberrant activation of the glucocorticoid receptor (GR) signaling pathway promotes tumor progression, chemoresistance, and immune evasion, providing a strong rationale for therapeutic targeting. Selective GR antagonists (SGRAs) represent an emerging novel strategy aimed at blocking this pro-tumorigenic pathway while minimizing off-target effects. Preclinical studies demonstrated that GR blockade restores chemosensitivity, particularly to taxane-based therapies, and may modulate the tumor microenvironment. These findings have translated into clinical evaluation, culminating in the phase 3 ROSELLA trial, which reported that the addition of relacorilant, a SGRA, to nab-paclitaxel significantly improved progression-free and overall survival in patients with recurrent PROC. These results, presented in March 2026, establish GR antagonism as a promising therapeutic strategy and a potential new treatment paradigm in this setting. In this evidence-based review, we summarize the biological basis of GR signaling in ovarian cancer, evaluate the clinical evidence supporting SGRAs, and discuss key challenges for implementation, including biomarker development, safety considerations, and rational combination strategies with chemotherapy, PARP inhibitors, and immunotherapy. We also highlight critical considerations for future clinical trial design to optimize the integration of GR-targeted therapies into the management of ovarian cancer.

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Vaginal Cancer outline the recommended diagnostic workup, staging considerations, and treatment options for this rare malignancy. Because vaginal cancer is uncommon and shares many biologic and clinical characteristics with cervical cancer, several management recommendations, particularly systemic therapy, are extrapolated from evidence and practices established for cervical cancer. This guideline excerpt summarizes key components of management, including diagnostic evaluation and workup, principles of staging, pathology considerations, radiation therapy principles, and primary treatment recommendations for both early-stage and advanced disease. It also details approaches to manage relapses, including locoregional recurrence and distant metastases, and provides an in-depth overview of systemic therapy recommendations for vaginal cancer. J Natl Compr Canc Netw 2026;24(3):101-126 doi:10.6004/jnccn.2026.0011

The NCCN Guidelines for Uterine Neoplasms provide recommendations for diagnostic workup, clinical staging, and treatment options for patients with endometrial cancer and uterine sarcoma. The NCCN Cervical Uterine Panel meets at least annually to review comments from reviewers within their institutions; examine relevant new data from publications, abstracts, and recent FDA approvals; and reevaluate and update recommendations. These NCCN Guidelines Insights summarize the panel's deliberations on the new FIGO 2023 staging system and updates on the new systemic therapy recommendations for the management of endometrial cancer.

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Cervical Cancer provide diagnostic workup, staging, and various treatment recommendations for cervical cancer based on clinical and surgical staging. This selection from the NCCN Guidelines for cervical cancer specifically focuses on diagnosis and workup, principles of staging and surgery, and primary treatment recommendations for early-stage and advanced disease and provides a detailed overview of systemic therapy recommendations for cervical cancer.

Vulvar cancer is annually diagnosed in an estimated 6,470 individuals and the vast majority are histologically squamous cell carcinomas. Vulvar cancer accounts for 5% to 8% of gynecologic malignancies. Known risk factors for vulvar cancer include increasing age, infection with human papillomavirus, cigarette smoking, inflammatory conditions affecting the vulva, and immunodeficiency. Most vulvar neoplasias are diagnosed at early stages. Rarer histologies exist and include melanoma, extramammary Paget’s disease, Bartholin gland adenocarcinoma, verrucous carcinoma, basal cell carcinoma, and sarcoma. This manuscript discusses recommendations outlined in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for treatments, surveillance, systemic therapy options, and gynecologic survivorship.

OBJECTIVES:To assess the efficacy and toxicity of paclitaxel and carboplatin (PC) compared to bleomycin, etoposide, and cisplatin (BEP) for treatment of newly diagnosed Stage IIA-IV or recurrent chemotherapy-naive ovarian sex cord-stromal tumors (SCST). METHODS:This phase II noninferiority trial randomly assigned patients to receive PC (6 cycles P 175 mg/m2 and C AUC = 6 IV every 3 weeks), or BEP (4 cycles B 20 units/m2 IV push day 1, E 75 mg/m2 IV days 1-5, and cisplatin 20 mg/m2 IV days 1-5 every 3 weeks). The primary endpoint was progression- free survival (PFS). This trial is registered with ClinicalTrials.gov, NCT01042522. RESULTS:At the interim analysis, 63 patients (31 PC and 32 B.P. had accrued between Feb 8, 2010 and Apr 30, 2020. Median age was 48 years. 87% had granulosa cell tumors. 37% had measurable disease. The DSMB closed accrual early for futility of PC arm. The futility analysis was supported by an estimated HR = 1.11 [95% CI: 0.57 to 2.13] which exceeded the pre-determined threshold for non-inferiority (1.10). Median PFS was 27.7 months [11.2 to 41.0] for PC and 19.7 months for BEP [95% CI: 10.4-52.7]. PC patients had fewer grade 3 or higher adverse events (PC 77% vs BEP 90%). CONCLUSIONS:The study met its pre-specified criterion for stopping early for futility and so failed to demonstrate non-inferiority of PC versus BEP in ovarian SCSTs, in a non-inferiority test with a hazard ratio margin of 1.1. Both PC and BEP may be considered in patients with advanced/recurrent SCST.

The NCCN Guidelines for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer provide multidisciplinary diagnostic workup, staging, and treatment recommendations for this disease. These NCCN Guidelines Insights detail how the evolution of the use of PARP inhibitors as maintenance and single-agent regimens for the treatment of ovarian cancer informed panel recommendations in the guidelines.

The NCCN Guidelines for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer provide multidisciplinary diagnostic workup, staging, and treatment recommendations for this disease. These NCCN Guidelines Insights detail how the evolution of the use of PARP inhibitors as maintenance and single-agent regimens for the treatment of ovarian cancer informed panel recommendations in the guidelines.

Adenocarcinoma of the endometrium (also known as endometrial cancer, or more broadly as uterine cancer or carcinoma of the uterine corpus) is the most common malignancy of the female genital tract in the United States. It is estimated that 65,950 new uterine cancer cases will have occurred in 2022, with 12,550 deaths resulting from the disease. Endometrial carcinoma includes pure endometrioid cancer and carcinomas with high-risk endometrial histology (including uterine serous carcinoma, clear cell carcinoma, carcinosarcoma [also known as malignant mixed Müllerian tumor], and undifferentiated/dedifferentiated carcinoma). Stromal or mesenchymal sarcomas are uncommon subtypes accounting for approximately 3% of all uterine cancers. This selection from the NCCN Guidelines for Uterine Neoplasms focuses on the diagnosis, staging, and management of pure endometrioid carcinoma. The complete version of the NCCN Guidelines for Uterine Neoplasms is available online at NCCN.org.

The NCCN Guidelines for Cervical Cancer provide recommendations for all aspects of management for cervical cancer, including the diagnostic workup, staging, pathology, and treatment. The guidelines also include details on histopathologic classification of cervical cancer regarding diagnostic features, molecular profiles, and clinical outcomes. The treatment landscape of advanced cervical cancer is evolving constantly. These NCCN Guidelines Insights provide a summary of recent updates regarding the systemic therapy recommendations for recurrent ormetastatic disease.

To assess the impact of the surgical route for interval surgery after neoadjuvant chemotherapy on overall and 5-year survival, 30- and 90-day mortality, length of stay, readmission rate, and residual disease among patients with advanced epithelial ovarian cancer.

To explore the association between travel distance to a treatment facility and the use of palliative therapy for patients with stage III and stage IV ovarian cancer.

Objective: Surgical feedback is critical for resident education, but lacks standardization. Global Operative Assessment of Laparoscopic Skills (GOALS) is used to evaluate resident training in laparoscopic cholecystectomy and appendectomy. This study examined the effectiveness of adapting GOALS for laparoscopic hysterectomy in a single residency-training program.Methods: A single-page evaluation form was used for senior resident-attending dyads who were performing laparoscopic hysterectomies together. Senior residents completed self-evaluations and attendings completed trainee evaluations after each case. A 10-item checklist detailed key steps in the operation. Evaluators used the checklist to indicate if trainees completed each step successfully. Five laparoscopic domains (GOALS) and assessment of case difficulty were scored on a 5-point scale. Overall satisfaction with resident performance was rated on a 10-point scale.Results: Over 21 months, 10 residents and 3 attendings completed 97 evaluations. The mean step completion resident score was 62% (attending score: 63%; p = 0.10), indicating agreement between operators and evaluators in case assessments. Compared to attending ratings of resident performances, residents rated themselves lower overall in the 5 laparoscopic domains (3.26 versus 3.53; p < 0.05) despite similar case difficulty estimates (2.66 versus 2.76; p = 0.43). Positive correlations between attending and resident scores indicated consistency between users.Conclusions: GOALS can standardize resident performance evaluation during laparoscopic hysterectomy. There was interevaluator agreement; trainees were more self-critical. An electronic format could make the form easier to use. (J GYNECOL SURG 20XX:000)

The NCCN Guidelines for Cervical Cancer provide recommendations for all aspects of management for cervical cancer, including the diagnostic workup, staging, pathology, and treatment. The guidelines also include details on histopathologic classification of cervical cancer regarding diagnostic features, molecular profiles, and clinical outcomes. The treatment landscape of advanced cervical cancer is evolving constantly. These NCCN Guidelines Insights provide a summary of recent updates regarding the systemic therapy recommendations for recurrent or metastatic disease.

Objectives: Cervical carcinoma is the fourth leading cause of cancer-related death among women worldwide. Previous randomized clinical trials showed a 30% to 50% decrease in risk of death in locally advanced cervical cancer (LACC) with the addition of concurrent platinum-based chemoradiotherapy when compared with radiotherapy alone. Mechanisms to account for improved efficacy are thought to include direct cytotoxicity, radiosensitization of tumor cells, and control of subclinical metastases. Anlotinib is an oral multi-targeted tyrosine kinase inhibitor (TKI) that strongly inhibits VEGFR, PDGFR, FGFR, and c-kit. Anlotinib synergizes with radiation and cisplatin, as shown in preclinical and clinical studies. This phase II study aims to evaluate the efficacy and safety of adding anlotinib to concurrent chemoradiotherapy in FIGO stage IB3 and IIB-IVA cervical cancer. Methods: Inclusion criteria include treatment-naive histologically confirmed FIGO stage IB3 to IVA cervical cancer with at least one measurable lesion and ECOG performance score 0-2 within the age range of 18 to 75 years. Abundant organ functions are required, with no contraindication to anlotinib or chemoradiation present. Patients will be treated with oral anlotinib (12 mg qd, d1-14; 21 days per cycle; total 3 cycles) and X-ray external-beam radiotherapy (total 45Gy-50Gy in 25-28 fraction), followed by brachytherapy (6Gy/5 fractions or 7Gy/4 fractions) with concurrent cisplatin (40 mg/m2 weekly for 5-6 weeks). The primary endpoint is the progression-free survival (PFS) rate at three years. The secondary endpoints include overall response rate (ORR), disease control rate (DCR), overall survival (OS), and quality of Life (QOL). Safety will be evaluated in all patients who receive study drugs according to the treatment received (safety population) by recording clinical adverse events (AEs) using National Cancer Institute Common. The sample size calculation of 47 patients provides 80% power to detect a difference in survival at the two-sided 5% significance level using the log-rank test; considering a 10% reduction, a total of 53 samples are required. This study is currently open, and 23 patients have been enrolled. The estimated primary completion date is December 1, 2024, and the estimated study completion date is October 31, 2025. Objectives: Cervical carcinoma is the fourth leading cause of cancer-related death among women worldwide. Previous randomized clinical trials showed a 30% to 50% decrease in risk of death in locally advanced cervical cancer (LACC) with the addition of concurrent platinum-based chemoradiotherapy when compared with radiotherapy alone. Mechanisms to account for improved efficacy are thought to include direct cytotoxicity, radiosensitization of tumor cells, and control of subclinical metastases. Anlotinib is an oral multi-targeted tyrosine kinase inhibitor (TKI) that strongly inhibits VEGFR, PDGFR, FGFR, and c-kit. Anlotinib synergizes with radiation and cisplatin, as shown in preclinical and clinical studies. This phase II study aims to evaluate the efficacy and safety of adding anlotinib to concurrent chemoradiotherapy in FIGO stage IB3 and IIB-IVA cervical cancer. Methods: Inclusion criteria include treatment-naive histologically confirmed FIGO stage IB3 to IVA cervical cancer with at least one measurable lesion and ECOG performance score 0-2 within the age range of 18 to 75 years. Abundant organ functions are required, with no contraindication to anlotinib or chemoradiation present. Patients will be treated with oral anlotinib (12 mg qd, d1-14; 21 days per cycle; total 3 cycles) and X-ray external-beam radiotherapy (total 45Gy-50Gy in 25-28 fraction), followed by brachytherapy (6Gy/5 fractions or 7Gy/4 fractions) with concurrent cisplatin (40 mg/m2 weekly for 5-6 weeks). The primary endpoint is the progression-free survival (PFS) rate at three years. The secondary endpoints include overall response rate (ORR), disease control rate (DCR), overall survival (OS), and quality of Life (QOL). Safety will be evaluated in all patients who receive study drugs according to the treatment received (safety population) by recording clinical adverse events (AEs) using National Cancer Institute Common. The sample size calculation of 47 patients provides 80% power to detect a difference in survival at the two-sided 5% significance level using the log-rank test; considering a 10% reduction, a total of 53 samples are required. This study is currently open, and 23 patients have been enrolled. The estimated primary completion date is December 1, 2024, and the estimated study completion date is October 31, 2025.

Epithelial ovarian cancer is the leading cause of death from gynecologic cancer in the United States, with less than half of patients living >5 years following diagnosis. The NCCN Guidelines for Ovarian Cancer provide recommendations for the diagnosis, evaluation, treatment, and follow-up for patients with ovarian, fallopian tube, and primary peritoneal cancers. These NCCN Guidelines Insights summarize the panel discussion behind recent important updates to the guidelines, including revised guidance on alternative chemotherapy regimens for patients with advanced age and/or comorbidities, a new algorithm for recurrent low-grade serous carcinoma based on developing research and novel therapeutic agents, and updated language regarding tumor molecular analysis applications in ovarian cancer.

Objectives: Minimally invasive surgical (MIS) staging has become the standard of care for low-grade clinical stage I endometrioid uterine cancer based on randomized studies demonstrating survival outcomes comparable to laparotomy. However, there is limited data on the use of MIS for high-grade uterine cancers at much higher risk for local disease extension and metastasis. The LACC trial showed inferior survival among early-stage cervical cancer patients undergoing MIS compared to laparotomy. The aim of this study was to test the hypothesis that MIS staging of type 2 uterine cancers would be associated with inferior survival. Methods: The National Cancer Database was used to identify women with type 2 uterine cancer (serous, carcinosarcoma, high-grade endometrioid, clear cell) diagnosed from 2010-2015 who underwent primary surgical management. Patients with low grade endometrioid uterine cancer were excluded. MIS included both laparoscopic and robotic approaches. Inverse probability of treatment weighting (IPTW) was used to balance confounders between the MIS and laparotomy groups. Variables in the propensity score model included age, race, median neighborhood education and income, insurance status, year of diagnosis, tumor stage, size, and grade, medical co-morbidities, facility type, and location. Kaplan-Meier curves and Cox regression were used to compare survival. Results: A total of 54,027 women (mean age 65.0±10.1 years) were included in the analysis. 33,763 (62.5%) underwent MIS approach. Compared to those in the laparotomy group, patients treated with MIS were noted to have tumors that were smaller, had earlier stage disease, and were less likely to be graded as poorly differentiated. Following weighting, the 5 year survival rates were 63.4% for laparotomy and 66.5% for MIS. (Figure 1). Patients treated with an MIS approach demonstrated significantly improved survival compared to an open approach (HR=0.87; 95% CI [0.84, 0.91], p<0.001). Conclusions: MIS staging was performed in two-thirds of patients with type 2 uterine cancer yet with significant baseline differences compared to the laparotomy group. Propensity score weighted matching was used in an attempt to create equivalent cohorts from this large retrospective sample. Our findings support the null hypothesis that MIS staging is not inferior to laparotomy, which are consistent with prior literature on type 1 uterine cancer and reinforce that MIS is the preferred approach for surgical staging of all types of uterine cancer. Minimally invasive surgical (MIS) staging has become the standard of care for low-grade clinical stage I endometrioid uterine cancer based on randomized studies demonstrating survival outcomes comparable to laparotomy. However, there is limited data on the use of MIS for high-grade uterine cancers at much higher risk for local disease extension and metastasis. The LACC trial showed inferior survival among early-stage cervical cancer patients undergoing MIS compared to laparotomy. The aim of this study was to test the hypothesis that MIS staging of type 2 uterine cancers would be associated with inferior survival. The National Cancer Database was used to identify women with type 2 uterine cancer (serous, carcinosarcoma, high-grade endometrioid, clear cell) diagnosed from 2010-2015 who underwent primary surgical management. Patients with low grade endometrioid uterine cancer were excluded. MIS included both laparoscopic and robotic approaches. Inverse probability of treatment weighting (IPTW) was used to balance confounders between the MIS and laparotomy groups. Variables in the propensity score model included age, race, median neighborhood education and income, insurance status, year of diagnosis, tumor stage, size, and grade, medical co-morbidities, facility type, and location. Kaplan-Meier curves and Cox regression were used to compare survival. A total of 54,027 women (mean age 65.0±10.1 years) were included in the analysis. 33,763 (62.5%) underwent MIS approach. Compared to those in the laparotomy group, patients treated with MIS were noted to have tumors that were smaller, had earlier stage disease, and were less likely to be graded as poorly differentiated. Following weighting, the 5 year survival rates were 63.4% for laparotomy and 66.5% for MIS. (Figure 1). Patients treated with an MIS approach demonstrated significantly improved survival compared to an open approach (HR=0.87; 95% CI [0.84, 0.91], p<0.001). MIS staging was performed in two-thirds of patients with type 2 uterine cancer yet with significant baseline differences compared to the laparotomy group. Propensity score weighted matching was used in an attempt to create equivalent cohorts from this large retrospective sample. Our findings support the null hypothesis that MIS staging is not inferior to laparotomy, which are consistent with prior literature on type 1 uterine cancer and reinforce that MIS is the preferred approach for surgical staging of all types of uterine cancer.

TPS5606 Background: Oregovomab binds tumor-associated CA125 rendering the target antigen CA125 more immunogenic or “neoantigen-like” through altered and enhanced antigen processing and presentation to specific T cells. This phenomenon is hypothesized to bypass tumor-associated immune suppression when administered in combination with chemotherapy. In a randomized phase II study, immunization with oregovomab in a schedule-dependent combination with paclitaxel and carboplatin induced tumor immunity and demonstrated significant improvement in PFS (median (months) 41.8 PCO vs 12.3 PCP, HR 0.44 p = 0.0027, and OS median N.E. PCO vs 43.2 PCP HR O.34 (p = 0.0077)) in patients with previously untreated EOC. The FLORA-5, the definitive confirmatory global registration trial, is currently recruiting patients in the front-line setting. Methods: The study is a phase 3, multicenter, double-blind, placebo-controlled clinical trial. Optimally debulked patients with FIGO III/IV EOC and serum CA125 > 50 U/ml receiving adjuvant (Cohort 1) or neoadjuvant (Cohort 2) chemotherapy will be randomized post-surgery to paclitaxel and carboplatin with or without oregovomab. Patients with germline BRCA1/2 mutations will be excluded. Chemotherapy will be administered every 3 weeks in both cohorts. Oregovomab/placebo is administered simultaneously at cycles 1, 3, and 5 of chemotherapy with a single maintenance dose at 12 weeks following cycle 5 in Cohort 1. Neoadjuvant patients (Cohort 2) will be administered oregovomab/placebo post interval debulking surgery at cycles 4 and 6 with maintenance doses at 6- and 18-weeks following cycle 6. No other post front-line maintenance therapy is permitted. The primary objective is PFS determined by RECIST 1.1 criteria. Cohort 1 will recruit 372 patients with a 90% power to detect a difference with an alpha of 0.025 and a hazard ratio of 0.65 when 252 PFS events have been observed. Cohort 2 will be analyzed separately recruiting 232 patients with a 90% power to detect a difference with an alpha of 0.025 and a hazard ratio of 0.60 when 165 PFS events have been observed. An interim analysis for futility will be performed. Secondary objectives include OS, frequency and severity of adverse events, and quality of life. Exploratory objectives include iRECIST, TFST, TSST, PFS2, and evaluation of potential biomarkers. The study is actively enrolling in the US with 9 patients enrolled at time of submission. Centers in Europe, South America and Asia are expected to begin accruing shortly. Clinical trial information: NCT04498117.