IJGC Podcast

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.

PARPi de-escalation in ovarian cancer with Giuseppe Caruso

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Giuseppe Caruso to discuss PARPi de-escalation in ovarian cancer. Dr. Caruso is a gynecologist, currently working as a research fellow at Mayo Clinic, Division of Gynecological Surgery, in Rochester (MN, USA) under the supervision of Professor William Cliby. He is also a PhD fellow in “Network Oncology and Precision Medicine” at Sapienza University of Rome in Italy and collaborates with the European Institution of Oncology in Milan (Italy) under the mentorship of Professor Nicoletta Colombo. His main areas of interest are ovarian cancer and precision oncology.
 
Highlights:
Systemic therapy de-escalation is a new frontier in personalizing therapy for advanced ovarian cancer.
PARPi are so effective that selected patients may require less systemic therapy to achieve the same outcomes.
The fundamental key is to limit de-escalation to BRCAm/HRD-positive patients with R0 after surgery.
Several de-escalation attempts are under investigation, but none is currently recommended outside of clinical trials.

HIPEC Complications with Rene Pareja, David Viveros-Carreño, and Beatriz Navarro Santana

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Rene Pareja, David Viveros-Carreño, and Beatriz Navarro Santana to discuss HIPEC complications. Dr. Viveros-Carreño is a Gynecologic Oncologist at Instituto Nacional de Cancerología, Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), and Clínica Universitaria Colombia in Bogotá, Colombia. Dr. Pareja is a gynecologist-oncologist at Astorga Oncology Clinic in Medellín and the National Cancer Institute in Bogotá, Colombia. Dr. Pareja is a reviewer for more than 20 specialty journals, and one of the Associate Editors for IJGC. He is the author of ten book chapters and more than 90 publications in peer-reviewed journals, and at IGCS 2021 he received an award for Community Advancement in Resource-Limited Settings. Dr. Navarro is a gynecologist-oncologist at Insular University hospital in Las Palmas, Spain. She also completed the ESGO fellowship at Institut Bergonie in France
 
Highlights:
The study aimed to assess the complications associated with HIPEC in cytoreductive surgery for epithelial ovarian cancer, examining two distinct time periods (2004–2013 and 2014–2022).
This systematic review analyzed 69 studies and including 4928 patients with advanced primary or recurrent epithelial ovarian cancer.
No significant differences were observed in complication rates between the two time periods. Overall, complications, including blood transfusions, gastrointestinal, infectious, respiratory, urinary complications, and thromboembolic events, showed no significant change.
Rates of ICU admissions, reoperations, and deaths also remained consistent over time.
The study concluded that the overall complications associated with HIPEC in ovarian cancer surgery did not decrease, and there was no reduction in the rates of ICU admissions, reoperations, or deaths.

Hormone Replacement Therapy after Cervical Cancer with Jason Wright

In this rebroadcast episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Jason Wright to discuss hormone replacement therapy after cervical cancer. Dr. Wright is the Sol Goldman Associate Professor and Chief of the Division of Gynecologic Oncology at Columbia University.
 
Highlights:
-Among cervical cancer patients <50 years of age who underwent surgery including oophorectomy or primary radiation, only 39% received estrogen replacement therapy.
-In patients who did receive estrogen replacement therapy the duration of use was short, with a median of only 60 days.
-Black patients were significantly less likely to receive estrogen replacement therapy than White patients.

Molecular Classification and Risk Stratification Endometrial Cancer” with Jenny Mueller and Bill Zammarrelli

In this rebroadcast episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Jenny Mueller and Bill Zammarrelli to discuss molecular classification and risk stratification in endometrial cancer. Jenny Mueller, MD, is a gynecologic oncologist and assistant attending in the department of surgery at Memorial Sloan Kettering Cancer Center. She leads the endometrial cancer research team at MSKCC with an emphasis on prospective, translational, and collaborative efforts within and across institutions. Bill Zammarrelli, MD, currently works as a gynecologic oncology fellow at Memorial Sloan Kettering Cancer Center. He is a commissioned officer in the US Army and completed his residency at Walter Reed National Military Medical Center. His current research focuses on the genetics of endometrial cancer. 
 
Highlights:
--PORTEC-1 and GOG-99 risk classifications are discordant for stage I grade 3 endometrioid endometrial carcinoma (EEC).
--Stage I grade 3 EECs of CN-high molecular subtype have a worse 3-year progression-free survival compared to non-CN-high molecular subtypes.
--Molecular classification in combination with clinicopathologic factors may provide improved prognostic information.

Low Grade Ovarian Cancer: The Expert Consensus,’ with Drs. Rachel Grisham, David Gershenson, and Brian Slomovitz

In this rebroadcasted episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Rachel Grisham, David Gershenson, and Brian Slomovitz to discuss "Low Grade Ovarian Cancer: The Expert Consensus". 
 
Highlights:  
A panel of experts convened in October 2022 to discuss recent scientific and clinical progress, resulting in a consensus document that provides recommendations for diagnosis, treatment, and ongoing research to improve patient care of low-grade serous ovarian cancer. 
Alterations affecting the MAPK pathway are frequent in low-grade serous ovarian cancer and provide prognostic information 
Recent advances in the use of targeted therapy (in particular with novel MEK inhibitor and endocrine therapy regimens) have led to unprecedented response rates in patients with recurrent low-grade serous ovarian cancer 

Uterine Transposition with Reitan Ribeiro

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Reitan Ribeiro to discuss uterine transposition. Dr. Ribeiro currently works in the Gynecology Oncology Service in the Department of Surgical Oncology at Erasto Gaertner Hospital in Curitiba, Brazil. He is a member of the IGCS Education Committee and serves as General Secretary of the Brazilian Society of Surgical Oncology (BSSO).
 
Highlights:
This prospective study aimed to assess the feasibility of uterine transposition and the result of fertility preservation in a group of non-gynecologic cancer patients post-radiation.
Of the eight patients who underwent uterine transposition, the uterus was successfully preserved in six patients; these patients had normal menses, hormonal levels, and vaginal intercourse after the procedure.
Three patients attempted to conceive, and two were spontaneously successful, subsequently delivering healthy babies via cesarean section without complications.
Uterine transposition could be a feasible option for preserving gonadal and uterine function in patients undergoing pelvic radiotherapy for nongynecological cancer.

SIENDO Trial with Ignace Vergote

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Professor Em. Ignace Vergote to discuss the SIENDO Trial. 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 88,000 times. He served as President of IGCS, ESGO, EORTC-GCG and ENGOT.
 
Highlights:
Selinexor inhibits Exportin-1, resulting in reactivation of Tumor Suppressor Proteins (especially p53) in the nucleus. This leads to selective killing of cancer cells.
The ENGOT-EN5/GOG-3055/SIENDO was a randomized phase III double-blind trial comparing maintenance selinexor with placebo, after response on chemotherapy in patients with advanced or first recurrence of endometrial cancer.
Median PFS in the ITT population was 5.7 versus 3.8 months (not significant).
Long-term PFS in TP53wt patients was 27.4 months and 5.3 months (HR 0.41) and in TP53wt/pMMR patients not reached and 4.9 months (HR: 0.32) for selinexor and placebo, respectively.
Selinexor is very promising in patients with advanced/recurrent TP53wt endometrial cancer and is further investigated in this population in the ongoing ENGOT-EN20/GOG-3083/XPORT-042 study.

SCCAN Study: Extent of Radical Hysterectomy in Cervical Cancer with Nicolò Bizzarri

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Nicolò Bizzarri to discuss the SCCAN study. Dr. Bizzarri is a former IJGC Editorial Fellow under the mentorship of Prof. Pedro Ramirez. He is a Gynecologic Oncologist at Policlinico Agostino Gemelli in Rome, president of the European Network of Young Gynecologic Oncologists (ENYGO), and he happily serves on the IJGC Editorial Board.
 
Highlights:
International guidelines recommend tailoring the radicality of hysterectomy according to the known pre-operative tumor characteristics in patients with early-stage cervical cancer. However, the survival benefit associated with the extent of radical hysterectomy is still a matter of debate.
Non-nerve-sparing radical hysterectomy was associated with improved 5-year disease-free survival compared to nerve sparing radical hysterectomy and represented an independent protective factor for risk of recurrence. Non-nerve sparing radical hysterectomy was associated with better 5-year disease-free survival in patients with tumors between 21-40 mm.
In patients with early-stage cervical cancer, the extent of radical hysterectomy was associated with disease-free survival improvement in patients with tumors between 21-40 mm but not in patients with tumors ≤20 mm.

Fagotti Score at Interval Surgery in Ovarian Cancer with Flurina Saner

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Flurina Saner to discuss the Fagotti Score at interval surgery in ovarian cancer. Dr. Saner, gynecologist and obstetrician, is a gynae oncology fellow at the University Hospital Inselspital Bern, Switzerland. Her research focuses on patients with ovarian cancer and clinical and molecular determinants for long-term survival.
 
Highlights:
The Fagotti score after neoadjuvant treatment shows a strong correlation with resection status, progression-free and overall survival of patients with advanced ovarian cancer
ΔFagotti – indicating the change of the score during neoadjuvant chemotherapy - tracks with outcome after neoadjuvant chemotherapy for ovarian cancer
Fagotti scores are valuable for an individualized patient treatment planning and should be routinely assessed at time of interval debulking surgery.
The prognostic value of the Fagotti score after neoadjuvant therapy should be further validated in a prospective study, f.e. the LANCE trial.