Table 3.

Front-line cancer-specific chemotherapy considerations for women with early-stage gynecologic malignancies during the COVID-19 pandemic.

High-grade ovary stage 1/2	Low-grade ovary stage 1/2	Germ cell tumors ovary	Endometrial	Cervix	GTN (low risk WHO score 0–6)
Platinum/taxane chemotherapy every 3 weeks [78]	Oral aromatase inhibitor monotherapy versus observation [7]	Hold bleomycin in dysgerminoma, consider holding bleomycin due to pulmonary toxicity, inability to obtain PFTs [61,62,79]	Platinum/taxane chemotherapy every 3 weeks (high risk histologic subtypes) [80,81]	Chemo-radiation in curative cases [82,83]	D and C prior to treatment if indicated and resources allow [65] MTX IM daily × 5 (0.4 mg/kg q 14 d) [67]
					MTX (1 mg/kg or 50 mg) IM D 1,3,5,7 with folinic acid rescue q 14 d [66]
					Consider MTX po
					Daily × 5 0.4 mg/kg,
					Dose cap = 25 mg/day
		Repeated in 14 d [68]
Consider observation for select early-stage patients (enrollment or following the guidance in COG study, AGCT1531, a Phase 3 Study of Active Surveillance for Low Risk and a Randomized Trial of Carboplatin vs. Cisplatin for Standard Risk Pediatric and Adult Patients with Germ Cell Tumors) [60]	Consideration of oral or intrauterine options, when available: levonorgestrel IUD (22) or megestrol acetate (23) for Gr 1/2 endometrioid histology [84,85]		Consider for score 0–1: MTX weekly 50 mg/m2 IM [69] Can also consider dactinomycin for all low risk GTD to reduce number of visits but must weigh against toxicity and need for central access [69]