IJGC Podcast

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.

Overall survival of SORAYA Trial with Robert Coleman

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Robert Coleman to discuss overall survival of SORAYA trial. Dr. Coleman completed his Obstetrics & Gynecology residency at Northwestern University Medical Center in Chicago, Illinois, and completed his fellowship at The University of Texas MD Anderson Cancer Center in 1993. From 1993-1996, he served as Assistant Professor at Creighton University followed by service as Vice-Chairman, Department of Obstetrics and Gynecology at the University of Texas, Southwestern Medical Center. Dr. Coleman joined as Faculty at MD Anderson Cancer center in 2004 and served as Professor and Executive Director for Cancer Network Research, holding the Ann Rife Cox Chair in Gynecology. In March 2020, he joined US Oncology Research (USOR) as Chief Scientific Officer and served briefly as Chief Medical Officer for Sarah Cannon Research Institute (SCRI). He currently serves as Chief Medical officer for Vaniam Group. Dr. Coleman has authored or coauthored over 750 scientific publications, including over 450 peer-reviewed articles, along with numerous book chapters, monographs, invited articles, and textbooks. He was the 2019 APGO-CREOG awardee for Excellence in Teaching. He serves as Vice President of GOG-Foundation, Inc. He served as President of SGO (2015-2016) and is the immediate Past-President of IGCS. He was recently inducted into MJH Life Sciences™ 2020 class of “Giants in Cancer Care®.”
 
Highlights:
Mirvetuximab soravtansine (MIRV) is a first-in-class antibody-drug conjugate comprising an  FRα-binding antibody, cleavable linker, and maytansinoid DM4, a potent tubulin-targeting agent
Early clinical data suggested efficacy in recurrent platinum-resistant ovarian cancer (PROC) prompting a larger trial to confirm both safety and efficacy in patients with PROC
In this SORAYA trial MIRV demonstrated clinically meaningful antitumor activity in patients with FRα-high platinum-resistant ovarian cancer with an ORR: 32.4% and a median DOR: 6.9 months Remarkably the median OS was 15 months; 37% patients alive at 24 months
Efficacy of MIRV was further evaluated with respect to when it was administered (as first treatment for PROC) and in patients receiving prior bevacizumab.  An ORR of 34.8% was documented in the formers, and 31.5% in the latter.
The ocular toxicity was new for many treating physicians when the drug first became available. However with mitigating strategies as used in the study the events were predictable, low-grade, and rarely (n=1 patient) led to treatment discontinuation
Now with MIRASOL confirming these data and demonstrating efficacy over standard of care for response, PFS, and unprecedently, OS, the agent is a staple of contemporary management.

Fertility Sparing Surgery in Cervical Tumors (less than 4cms) with Kirsten Jorgensen and Alex Melamed

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Kirsten Jorgensen and Alex Melamed to discuss fertility sparing surgery in cervical tumors (<4 cms). Kirsten Jorgensen grew up in Juneau, Alaska. She completed her undergraduate degree at Harvard College, following that she spent a year working in Lima, Peru for Partners In Health as part of a post-graduate scholarship. She then completed medical school at the University of Washington followed by residency in obstetrics and gynecology at Tufts Medical Center in Boston, Massachusetts. She just began her final year of gynecologic oncology fellowship at MD Anderson Cancer Center in Houston, Texas. Dr. Alexander Melamed is a gynecologic oncologist and clinical outcomes researcher at Massachusetts General Hospital, and an Associate Professor in the department of Obstetrics, Gynecology and Reproductive biology at Harvard Medical School. His research seeks to understand how healthcare delivery impacts patient outcomes. Dr. Melamed has a strong interest in study design and methods for causal inference.
 
Highlights:
-Current guidelines offer mixed recommendations for fertility-sparing surgery for those with a cervical cancer tumor size between 2cm and 4cm
-This work sought to critically assess how the oncologic risk changes as tumor size increases without placing artificial cutoffs
-Results must be interpreted within the limitations of a database study, but do seem to suggest that there is not a significant inflection of risk at 2cm, or any other size up to 4cm.

Updates on Endometrial Cancer in Latin America with Mansoor Mirza and Angélica Nogueira Rodrigues

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Mansoor Mirza and Angélica Nogueira Rodrigues to discuss recent updates on endometrial cancer in Latin America. Dr. Mirza is a highly qualified medical oncologist with expertise in Medical and Radiation Oncology, holding multiple degrees and licenses in these fields. He currently serves as the Chief Oncologist at the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Denmark, and holds the position of Medical Director of the Nordic Society of Gynaecologic Oncology-Clinical Trial Unit (NSGO-CTU). Dr. Mirza is actively involved in numerous medical societies, clinical research, and international trial collaborations, and has contributed significantly to the development of clinical protocols and guidelines for the management of various cancers. Dr. Angélica Nogueira-Rodrigues is the Founder of EVA Group, and President-elect of the Brazilian Society of Medical Oncology. She is also a Researcher and Professor at Federal University, MG, Brazil, and Chair of Gynecology at the Latin America Cooperative Oncology Group (LACOG).
 
Highlights:
 
-Detailed epidemiological data on endometrial cancer in Latin America are scant, but GLOBOCAN provides estimates for the incidence of uterine cancer within countries globally. EC is the second gyn cancer in the region, due to the burden of CC which is still the first one. It is estimated that the total number of new cases of uterine cancer in Latin America and the Caribbean will rise from approximately 33,000 in 2020 to an estimated 51,000 in 2040;
-The last ten years have been marked by a radical transformation in the understanding of the molecular biology of endometrial cancer, and, including it.  or not  in FIGO staging, this discussion needs to evolve and be incorporated into clinical practice  in Latin America, as it impacts clinical decision, hereditary cancer diagnosis, among others.
-The main message for young gynecological oncologists as us to create a future medicine with fewer disparities worldwide is to strive  to get access an implement the best for the patient,  avoiding protocols adapted for low-income countries which can negatively impact the clinical outcomes.

Radiation Alone vs Chemoradiation in Endometrial Cancer Recurrence with Ann H. Klopp

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Ann H. Klopp to discuss radiation alone vs chemoradiation in endometrial cancer recurrence. Dr. Ann H. Klopp is a Professor of Radiation Oncology at MD Anderson Cancer Center, the head of the Gynecologic Oncology Section and a physician-scientist specializing in the treatment of gynecologic cancers. Her research focuses on improving outcomes for women with gynecologic cancers by enhancing tumor directed immune response in combination with radiation therapy and using advanced techniques to increase precision of radiation treatment delivery.
Highlights:
NRG0238 compared chemoradiation to radiation alone for patients with locally recurrent endometrial cancer and found that the addition of chemotherapy did not improve progression-free survival.
Radiation therapy is highly effective for treatment for local recurrences of endometrial cancer.
The nuances of patients enrolled and treatment delivered are discussed.