IJGC Podcast

LVSI Classification and Impact on Outcomes in Stage I Endometrial Cancer with Drs. Christian Dagher and Nadeem Abu-Rustum

Nadeem Abu-Rustum bio: Dr. Abu-Rustum is a board-certified gynecologic oncologist who specializes in the surgical treatment of gynecologic cancers at Memorial Sloan Kettering Cancer Center. He is also a professor of obstetrics and gynecology at Weill Cornell Medical College. Dr. Abu-Rustum has a special interest in minimally invasive surgery (laparoscopy) for the treatment of cancerous and noncancerous diseases of the female reproductive system, and his clinical research focuses on surgical therapy for gynecologic cancers and innovative surgical approaches to treating gynecologic disorders.
Christian Dagher bio: Christian Dagher is a former research fellow at Memorial Sloan Kettering, and current OBGYN resident at the University of Pennsylvania. He holds a master's degree in clinical epidemiology and health-services research from Weill-Cornel. Before moving to the US, he completed an OBGYN residency at the American University of Beirut and is interested in studying survival biomarkers in endometrial cancer. 
Highlights:
The 2023 FIGO staging system for endometrioid endometrial carcinomas included the extent of lymphovascular invasion as a determinant of stage.
The new staging system, groups tumors with no lymphovascular space invasion and those with focal invasion (<5 vessels) into one category and upstages those with substantial invasion ( 5 or more vessels).
This study aimed to evaluate the relationship between the extent of lymphovascular invasion and oncologic outcomes in patients with stage I endometrioid endometrial cancer.
This study is a retrospective analysis of 1555 patients with FIGO 2009 stage I endometrioid endometrial cancer who underwent total hysterectomy and lymph node assessment at two tertiary centers between 2012 and 2019, categorized by the extent of lymphovascular invasion (no, focal, or substantial invasion as defined by the WHO).
Key findings showed that both focal and substantial lymphovascular invasion were linked to lower 5-year progression-free survival (68.7% and 70.5% for substantial and focal invasion, respectively, compared to 90.7% for no invasion). This was true even after limiting the analysis to myoinvasive grades 1 and 2. 
In conclusion, focal and no lymphovascular invasion have different prognostic outcomes and should not be combined into a single category as proposed by the FIGO staging system. Focal and substantial lymphovascular invasion were not associated with distinct prognostic outcome that could support upstaging of the latter.

Tisotumab Vedotin in Second- & Third-Line Recurrent Cervical Cancer with Dr. Ignace Vergote

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Ignace Vergote to discuss Tisotumab Vidotin in Second- & Third-Line Recurrent Cervical Cancer. Prof. Vergote was Chairman of the Department of Gynaecology and Obstetrics at the Catholic University Leuven from 2003-2020. He published more than 1050 papers on gynecologic cancer in peer-reviewed journals, and his work was cited more than 90,000 times. He served as President of IGCS, ESGO, EORTC-GCG and ENGOT.
 
Highlights:
Patients with recurrent cervical cancer with progression after platinum/paclitaxel, combined if possible with bevacizumab and anti-PD-(L)1 therapy, have a dismal prognosis
The antibody-drug -conjugate tisotumab vedotin showed a statistically significant and clinically meaningful improvement in overall survival, demonstrating a 30% reduction in the risk of death compared with standard of care chemotherapy
Consistent benefit in progression-free survival and confirmed response were also observed and supportive of the observed overall survival benefit with tisotumab vedotin
The safety profile of tisotumab vedotin was manageable and tolerable, and consistent with previous experience
Based on these data, tisotumab vedotin should be considered a potential new standard of care for patients with recurrent cervical cancer who have progressed after first-line systemic therapy

Elikia: a hope for cervical cancer in Congo with Dr. Luis Chiva

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Luis Chiva to discuss the Elikia project in the Democratic Republic of the Congo. Dr. Luis Chiva is the Head of Gynecology and Obstetrics and Director of Gynecologic Oncology at at Clínica Universidad de Navarra.
 
Highlights:
Inspiration: Dr. Luis Chiva began the Elikia project in the DRC in 2016 after seeing the urgent need for cervical cancer screening and maternal health.
Screening Approach: The project uses visual inspection with acetic acid, inspired by a successful model from India, to reduce cervical cancer mortality.
Team and Challenges: A team of volunteers faces challenges like limited healthcare infrastructure and promoting preventive care.
Sustainability: The project relies on donations and grants  to remain sustainable.
Personal Impact: The work has profoundly influenced Dr. Chiva, renewing his commitment to humanitarian efforts.

Role of Chemotherapy following Chemoradiation After Radical Hysterectomy with Dr. Anuja Jhingran

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Anuja Jhingran to discuss the role of chemotherapy following chemoradiation after radical hysterectomy. Dr. Anuja Jhingran is a Professor of Radiation Oncology specializing in gynecologic cancers. Her clinical focus includes advanced ovarian, cervical, and endometrial cancers, utilizing advanced radiation techniques to reduce toxicity. Dr. Jhingran is actively involved in research with the Radiation Therapy Oncology Group (RTOG) and Gynecologic Oncology Group (GOG), serving as the national Principal Investigator for several studies. She is passionate about women's health and works internationally to improve healthcare in developing countries.
 
Highlights:
This study assessed the impact of adding adjuvant chemotherapy to chemoradiotherapy (CRT) in patients with high-risk early-stage cervical cancer post-radical hysterectomy. 
A total of 212 patients were analyzed, with 109 receiving CRT alone and 103 receiving CRT plus chemotherapy. 
The 4-year disease-free survival (DFS) was 76% for the CRT group and 77% for the CRT plus chemotherapy group (HR = 1.05, 90% CI: 0.65-1.68, p = 0.56). 
Overall survival (OS) rates at 4 years were 87% for CRT and 89% for the CRT plus chemotherapy arm (HR = 0.91, 90% CI: 0.49-1.69, p = 0.40). 
The addition of chemotherapy did not significantly improve DFS or OS.  

ERAS Guidelines and Outcomes Meta-analysis with Dr. Gregg Nelson

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Gregg Nelson to discuss ERAS Guidelines and Outcomes Meta-analysis. Dr. Gregg Nelson is Professor and Chair of Gynecologic Oncology at the University of Calgary, in Calgary, Canada. He is the Physician Lead for ERAS Alberta and is Co-Chair of Enhanced Recovery Canada. 
Highlights:
Largest meta-analysis of ERAS randomized clinical trials finds hospital length of stay decreased by 1.9 days overall and risk of complications decreased by 29%, in favor of ERAS
ERAS can be applied to both open and minimally invasive surgery
ERAS benefits multiple surgery types

Fertility-sparing surgery in borderline ovarian tumors with Drs. Timo Westermann and Philipp Harter

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Timo Westermann and Philipp Harter to discuss fertility-sparing surgery in borderline ovarian tumors. Dr. Timo Westermann is a gynecologist and fellow at the Department of Gynecologic Oncology at Kliniken Essen-Mitte. Dr. Philipp Harter is a gynecologic oncologist, working at Kliniken Essen Mitte and Chair of the AGO Study Group.
 
Highlights:
 
Fertility-Sparing Surgery in Borderline-Tumors does not negatively impact overall survival.
Higher recurrence rates are observed after fertility-sparing surgery, particularly in higher FIGO stages.
Long-term follow up is crucial due to potential risk of late recurrences.

SENECA Study: Molecular profiling and SLN with Enrique Chacón

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Enrique Chacón to discuss the SENECA Study: Molecular profiling and SLN. Dr. Chacón works in the Gynecologic Oncology Unit of the Clínica Universidad de Navarra. Dr. Chacón is an active member of the European Society of Gynecologic Oncology where he is the co-chair of the ENYGO Online Education Committee and the national representative of Spain. In 2021 he completed his editorial fellowship in the IJGC, where today he is serving on the Editorial Board of the journal.
 
Highlights:
 
This study, for the first time, reveals significant differences in SLN involvement among more than 2000 patients with early-stage endometrial cancer based on their molecular subtypes, with the p53 abn and MMRd groups having the greatest lymph node involvement.
The study defined the risk of SLN involvement for each of the ESGO risk groups. In this sense, the study notes that molecular profiling does not improve the prediction of nodal status with respect to the classical risk factors (FIGO stage and histology).
Lymph node staging should not yet be adopted based on molecular profiling as prospective studies are needed to validate whether these differences impact survival (DFS/OS)

IJGC EiC Summer Podcasts: OVHIPEC1 Overall Survival Analysis with Lot Aronson and Willemien J. van Driel

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Lot Aronson and Willemien van Driel to discuss OVHIPEC1 overall survival analysis. Dr. van Driel is a gynecological oncologist at the Netherlands Cancer Institute since 2004 and has, amongst others, a special interest in determining the role of HIPEC in the treatment of patients with advanced ovarian carcinoma and is PI of the OVHIPEC 1 and OVHIPEC 2 study. Dr. Aronson is a medical doctor currently pursuing a PhD in Gynaecological Oncology at the Netherlands Cancer Institute in Amsterdam. Her research focuses on hyperthermic intraperitoneal chemotherapy (HIPEC) as well as immunotherapy in primary advanced ovarian cancer. 
 
Highlights:
The long-term survival analysis of the OVIHPEC-1 study confirms the significant improvement in progression-free and overall survival when adding HIPEC to interval cytoreductive surgery in patients with FIGO stage III ovarian carcinoma for whom primary cytoreduction is not considered feasible due to extensive disease.
Neither the number of lines nor the type of subsequent treatment for recurrence differed between the treatment groups. Therefore, the observed improvement in overall survival is unlikely to be attributable a difference in subsequent therapies.
Identification of biomarkers (e.g. BRCA/HRD status) to select patients for HIPEC and the combination of HIPEC with PARP inhibitors warrants further investigation.

IJGC EiC Summer Podcasts: The INTERLACE Trial with Mary McCormack

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Mary McCormack to discuss the INTERLACE trial. Dr. McCormack is an Honorary Consultant Clinical Oncologist at University College London Hospitals NHS Trust and an Honorary Associate Clinical Professor at University College London.
 
Highlights:
• INTERLACE first randomised PH3 trial in Locally advanced cervical cancer in more than 2 decades to demonstrate a clinically meaningful and statistically significant improvement in both OS and PFS .
• The IC drugs are widely available and relatively cheap so removing many potential economic barriers to adoption.
• Growth factors -GCSF/Filgrastim should be used as needed to ensure patients complete the chemotherapy (IC & cisplatin)
• Essential to BEGIN the external beam radiation within 7 days of last dose ( #6) of IC.
• Remember OVERALL treatment time for the RADIATION- 96% in trial completed both EXTERNAL BEAM & BRACHYTHERAPY within 56 days.

IJGC EiC Summer Podcasts: SLN in Endometrial Hyperplasia with Andrea Rosati

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Andrea Rosati. Mr. Rosati is a consultant at the Department of Gynecologic Oncology at Fondazione Policlinico Universitario Agostino Gemelli in Rome (Italy). He is currently attending a second level master "Gynecologic Oncology International Master" at the Catholic University of the Sacred Heart (Rome, Italy) accredited as a Subspecialty Fellowship by the European Society of Gynaecological Oncology. His main interest areas are gynecological cancer, surgical anatomy, and gynecologic oncology surgery.
 
Highlights:
This study evaluated the prevalence of concurrent endometrial cancer in patients with pre-operative diagnoses of atypical endometrial hyperplasia undergoing hysterectomy. 
Among 460 patients, 47.2% were found to have concurrent endometrial cancer. Sentinel lymph node biopsy provided prognostic and therapeutic information in 60.8% of cases. 
It also allowed for the adjustment of adjuvant therapy in 12.3% of high to intermediate-risk patients without increasing operative time or complication rates. 
The study suggests sentinel lymph node biopsy can provide valuable prognostic and therapeutic insights in managing atypical endometrial hyperplasia.