Table 4.

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

High-grade ovary	Low-grade ovary	Endometrial	Cervix	Vulva	GTN (high risk WHO score ≥ 7)	Leiomyosarcoma
Neoadjuvant chemotherapy preferred over primary debulking in high COVID burden regions [4,5] Platinum/taxane chemotherapy every 3 weeks [6]; consider thoughtful incorporation of bevacizumab (i.e., stage IV, significant ascites) [18,25]	Chemotherapy followed by aromatase inhibitor therapy vs. aromatase inhibitor monotherapy [7,86]	Platinum/taxane Chemotherapy every 3 weeks [87]	Chemoradiation for curative cases [[13], [14], [15]]	Neoadjuvant chemo- radiation [88]	Inpatient EMA-CO for choriocarcinoma [89] EMA-EP for placental site trophoblastic tumor (PSTT) [70]	Single agent doxorubicin q 3 wks [57]
Preferred oral maintenance PARPi vs. bevacizumab use based on assessment of COVID 19 exposure risk vs. benefit or observation only	Low threshold to transition to oral hormonal maintenance	Avoid radiation unless indicated for curative intent	Paclitaxel/carboplatin [12] or taxane/platinum with bevacizumab every 3 weeks (weigh survival benefit versus risk of fistula) [12,16]			Aromatase inhibitors in ER+ uLMS [58] Oral pazopanib [52]
		Consideration of oral options: megestrol acetate, or megestrol acetate alternating tamoxifen, oral everolimus/ letrozole, weigh increased toxicity over above hormone regimens [[9], [10], [11]]	Stage IV and high risk for COVID-19 morbidity consider delaying/deferring non-curative intent treatment; goals of care discussion
		Stage IV (high grade) and high risk for COVID-19 morbidity - consider delaying/deferring non-curative intent treatment; goals of care discussion