Inclusion Criteria:  Adult females > 18 years old Advanced or recurrent gynecological cancer patients from AHMG Advent Health Orlando Gynecologic Oncology Group Patients for whom an immunotherapy regimen has been ordered  Exclusion Criteria:  Patients unable to provide fecal specimens at three time points Patients unable to read or understand informed consent  Taking medications that may affect gut microbiome:  Proton pump inhibitors (PPIs) Metformin Antibiotics Laxatives Patients who are receiving investigational agent