Gynecological Cancers Translational, Research Implementation, and Harmonization: Gynecologic Cancer InterGroup Consensus and Still Open Questions

In the era of personalized medicine, the introduction of translational studies in clinical trials has substantially increased their costs, but provides the possibility of improving the productivity of trials with a better selection of recruited patients. With the overall goal of creating a roadmap to improve translational design for future gynecological cancer trials and of defining translational goals, a main discussion was held during a brainstorming day of the Gynecologic Cancer InterGroup (GCIG) Translational Research Committee and overall conclusions are here reported. A particular emphasis was dedicated to the new frontier of the immunoprofiling of gynecological cancers. The discussion pointed out that to maximize patients’ benefit, translational studies should be integral to clinical trial design with standardization and optimization of procedures including a harmonization program of Standard Operating Procedures. Pathology-reviewed sample collection should be mandatory and ensured by dedicated funding. Biomarker validation and development should be made public and transparent to ensure rapid progresses with positive outcomes for patients. Guidelines/templates for patients’ informed consent are needed. Importantly for the public, recognized goals are to increase the involvement of advocates and to improve the reporting of translational data in a forum accessible to patients.

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Future opportunities of the Gynecological Cancer Intergroup

International Journal of Gynecological Cancer ◽

10.1111/j.1525-1438.2007.01108.x ◽

2008 ◽

Vol 18 (Suppl 1) ◽

pp. 71-73 ◽

Cited By ~ 1

Author(s):

G. C.E. Stuart

Keyword(s):

Clinical Trials ◽

Translational Research ◽

International Collaboration ◽

Gynecological Cancer ◽

Gynecologic Cancer ◽

Phase Iii ◽

Phase Iii Clinical Trials ◽

Global Partnerships

The Gynecologic Cancer Intergroup (GCIG) is an international collaboration of cooperative clinical trials groups who conduct randomized phase III clinical trials in the population of women affected by gynecologic cancer. This collaboration amongst 18 member groups allows for rapid accrual of women to such trials with outcomes that are rapidly generated and readily generalizable to a broad population. Future considerations should include studies in prevention and translational research through improved processes and new global partnerships

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CyberKnife Stereotactic Ablative Radiotherapy for Recurrent or Oligometastatic Gynecological Cancers

South Asian Journal of Cancer ◽

10.1055/s-0041-1731576 ◽

2021 ◽

Author(s):

Tejinder Kataria ◽

Pushpa Naga ◽

Susovan Banerjee ◽

Deepak Gupta ◽

Kushal Narang ◽

...

Keyword(s):

Cancer Patients ◽

Gynecological Cancer ◽

Dose Range ◽

Gynecologic Cancer ◽

Local Tumor Control ◽

Tumor Control ◽

Stereotactic Ablative Radiotherapy ◽

Gynecological Cancers ◽

Study Results ◽

Grade 3

Abstract Purpose Use of stereotactic ablative radiotherapy (SABR) in the treatment of recurrent or metastatic lesions from a primary gynecologic cancer is a relatively new concept. The present study aims to assess the safety, efficacy, and possible toxicity profile of CyberKnife SABR, recurrent or metastatic disease. Materials/Methods CyberKnife VSI-based SABR was offered to 20 oligometastatic/recurrent gynecological cancer patients between 2013 and 2019. Patient, tumor, and treatment characteristics including radiotherapy details, clinical outcome in terms of local control rates, and toxicities are reported in this study. Results Twenty-five recurrent or oligometastatic lesions for 20 primary gynecologic cancer patients including cervical (n = 8), ovarian (n = 6), endometrial (n = 5), and vulvar (n = 1) cancers were analyzed. Of these, 4 (16%) were intracranial lesions and remaining 21 (84%) were extracranial, consisting of 14 (67%) extrapelvic and 7 (33%) pelvic lesions. The median SABR dose delivered was 60 Gy biologically effective dose (range 42–133 Gy) in an average of four fractions (range 1–6). The mean follow-up was 18 (range 2–70) months. Local tumor control was achieved in 82% of patients. There was no grade ≥ 3 toxicity recorded. Conclusion Our study results suggest that CyberKnife SABR is an effective treatment modality with no major morbidity in patients with recurrent or oligometastatic gynecological cancers.

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Current Possibilities of Gynecologic Cancer Treatment with the Use of Immune Checkpoint Inhibitors

International Journal of Molecular Sciences ◽

10.3390/ijms20194705 ◽

2019 ◽

Vol 20 (19) ◽

pp. 4705 ◽

Cited By ~ 13

Author(s):

Ewelina Grywalska ◽

Małgorzata Sobstyl ◽

Lechosław Putowski ◽

Jacek Roliński

Keyword(s):

Monoclonal Antibodies ◽

Immune Checkpoint ◽

Immune Checkpoint Inhibitors ◽

Cytotoxic T Lymphocyte ◽

Checkpoint Inhibitors ◽

Gynecological Cancer ◽

Gynecologic Cancer ◽

Gynecological Cancers ◽

Cancer Burden ◽

Medical Need

Despite the ongoing progress in cancer research, the global cancer burden has increased to 18.1 million new cases and 9.6 million deaths in 2018. Gynecological cancers, such as ovarian, endometrial, and cervical cancers, considerably contribute to global cancer burden, leading to $5,862.6, $2,945.7, and $1,543.9 million of annual costs of cancer care, respectively. Thus, the development of effective therapies against gynecological cancers is still a largely unmet medical need. One of the novel therapeutic approaches is to induce anti-cancer immunity by the inhibition of the immune checkpoint pathways using monoclonal antibodies. The molecular targets for monoclonal antibodies are cytotoxic T lymphocyte-associated protein-4 (CTLA-4), programmed cell death protein-1 (PD-1), and programmed death-ligand 1 (PD-L1). The rationale for the use of immune checkpoint inhibitors in patients with gynecological cancers was based on the immunohistological studies showing high expression levels of PD-1 and PD-L1 in those cancers. Currently available immune checkpoint inhibitors include nivolumab, pembrolizumab, atezolizumab, avelumab, durvalumab, and ipilimumab. The efficacy and safety of these inhibitors, used as monotherapy and with combination with chemotherapy, is being currently evaluated in several clinical studies. As the results are promising, more clinical trials are being planned, which may lead to the development of efficient therapies for gynecological cancer patients.

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Relationship between Air Pollutant Exposure and Gynecologic Cancer Risk

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105353 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5353

Author(s):

Qiwei Yu ◽

Liqiang Zhang ◽

Kun Hou ◽

Jingwen Li ◽

Suhong Liu ◽

...

Keyword(s):

Air Pollution ◽

Cancer Risk ◽

Air Pollutants ◽

Gynecological Cancer ◽

Gynecologic Cancer ◽

Ambient Air ◽

Air Pollutant ◽

Ambient Air Pollution ◽

Short Term Exposure ◽

Increased Risk

Exposure to air pollution has been suggested to be associated with an increased risk of women’s health disorders. However, it remains unknown to what extent changes in ambient air pollution affect gynecological cancer. In our case–control study, the logistic regression model was combined with the restricted cubic spline to examine the association of short-term exposure to air pollution with gynecological cancer events using the clinical data of 35,989 women in Beijing from December 2008 to December 2017. We assessed the women’s exposure to air pollutants using the monitor located nearest to each woman’s residence and working places, adjusting for age, occupation, ambient temperature, and ambient humidity. The adjusted odds ratios (ORs) were examined to evaluate gynecologic cancer risk in six time windows (Phase 1–Phase 6) of women’s exposure to air pollutants (PM2.5, CO, O3, and SO2) and the highest ORs were found in Phase 4 (240 days). Then, the higher adjusted ORs were found associated with the increased concentrations of each pollutant (PM2.5, CO, O3, and SO2) in Phase 4. For instance, the adjusted OR of gynecological cancer risk for a 1.0-mg m−3 increase in CO exposures was 1.010 (95% CI: 0.881–1.139) below 0.8 mg m−3, 1.032 (95% CI: 0.871–1.194) at 0.8–1.0 mg m−3, 1.059 (95% CI: 0.973–1.145) at 1.0–1.4 mg m−3, and 1.120 (95% CI: 0.993–1.246) above 1.4 mg m−3. The ORs calculated in different air pollution levels accessed us to identify the nonlinear association between women’s exposure to air pollutants (PM2.5, CO, O3, and SO2) and the gynecological cancer risk. This study supports that the gynecologic risks associated with air pollution should be considered in improved public health preventive measures and policymaking to minimize the dangerous effects of air pollution.

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GYNOCARE Update: Modern Strategies to Improve Diagnosis and Treatment of Rare Gynecologic Tumors—Current Challenges and Future Directions

Cancers ◽

10.3390/cancers13030493 ◽

2021 ◽

Vol 13 (3) ◽

pp. 493

Author(s):

Riccardo Di Fiore ◽

Sherif Suleiman ◽

Bridget Ellul ◽

Sharon A. O’Toole ◽

Charles Savona-Ventura ◽

...

Keyword(s):

Cancer Research ◽

Gynecological Cancer ◽

Gynecologic Cancer ◽

Delayed Diagnosis ◽

Research Programme ◽

Basic Research ◽

Diagnosis And Treatment ◽

Rare Cancer ◽

Cost Action ◽

Gynecologic Tumors

More than 50% of all gynecologic tumors can be classified as rare (defined as an incidence of ≤6 per 100,000 women) and usually have a poor prognosis owing to delayed diagnosis and treatment. In contrast to almost all other common solid tumors, the treatment of rare gynecologic tumors (RGT) is often based on expert opinion, retrospective studies, or extrapolation from other tumor sites with similar histology, leading to difficulty in developing guidelines for clinical practice. Currently, gynecologic cancer research, due to distinct scientific and technological challenges, is lagging behind. Moreover, the overall efforts for addressing these challenges are fragmented across different European countries and indeed, worldwide. The GYNOCARE, COST Action CA18117 (European Network for Gynecological Rare Cancer Research) programme aims to address these challenges through the creation of a unique network between key stakeholders covering distinct domains from concept to cure: basic research on RGT, biobanking, bridging with industry, and setting up the legal and regulatory requirements for international innovative clinical trials. On this basis, members of this COST Action, (Working Group 1, “Basic and Translational Research on Rare Gynecological Cancer”) have decided to focus their future efforts on the development of new approaches to improve the diagnosis and treatment of RGT. Here, we provide a brief overview of the current state-of-the-art and describe the goals of this COST Action and its future challenges with the aim to stimulate discussion and promote synergy across scientists engaged in the fight against this rare cancer worldwide.

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National and Subnational Trends of Incidence and Mortality of Female Genital Cancers in Iran; 1990–2016

Archives of Iranian Medicine ◽

10.34172/aim.2020.40 ◽

2020 ◽

Vol 23 (7) ◽

pp. 434-444

Author(s):

Sahar Eftekharzadeh ◽

Narges Ebrahimi ◽

Mehrnoosh Samaei ◽

Farnam Mohebi ◽

Bahram Mohajer ◽

...

Keyword(s):

Cervical Cancer ◽

Incidence Rate ◽

Gynecological Cancer ◽

Fold Increase ◽

Mortality Rates ◽

Incidence Rates ◽

Gynecological Cancers ◽

Corpus Uteri ◽

National Mortality ◽

Incidence And Mortality

Background: The present study aims to assess the incidence and mortality rates of gynecological cancers and their changes from 1990 to 2016 at national and subnational levels in Iran. Methods: Annual estimates of incidence and mortality for gynecological cancers from 1990 to 2016 at national and subnational levels were generated as part of a larger project entitled National and Subnational Burden of Diseases, Injuries, and Risk Factors (NASBOD). After the precise processing of data extracted from the Iran Cancer Registry, annual age-standardized incidence and mortality rates were calculated for each cancer, province, year and age group during the period of the study. Results: In 2016, gynecological cancers constituted 8.0% of new cancer cases among women of all ages compared to 3.7% of new cases of cancer among women in 1990. The incidence rate of gynecological cancers has increased from 2.5 (0.9-5.6) per 100000 women in 1990 to 12.3 (9.3–15.7) per 100000 women in 2016, and the most common gynecological cancer has changed from cervical cancer in 1990 to corpus uteri cancer in 2016. Age-standardized incidence rates of ovarian, corpus uteri and vulvovaginal cancers increased from 1.3 (0.5–2.4), 1.7 (0.6–3.0), and 0.3 (0.0–0.7) in 1990 to 4.4 (3.6–5.2), 9.9 (6.8–13.4), and 0.6 (0.2–1.0) in 2016, respectively, showing a 3.3, 5.8 and 1.7-fold increase during this period. Age-standardized incidence rate of cervical cancer was 2.4 (1.7–3.3) cases per 100000 women in 2016 and did not differ significantly from the beginning of the study. An overall reduction was seen in national mortality to incidence ratios (MIR) from 2000 to 2015. Conclusion: The incidence rates of all gynecological cancers in different provinces have shown a converging trend that could indicate that attempts toward health equality have been effective. The declining trend of MIR could be interpreted as advancements in detection of cancer in its early stages and also improvements in treatments, in turn reflecting improvements in access to and quality of care.

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Synchronous gynecologic cancer and the use of imaging for diagnosis

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.62.02.116 ◽

2016 ◽

Vol 62 (2) ◽

pp. 116-119

Author(s):

Camila Silva Boaventura ◽

José Lucas Scarpinetti Galvão ◽

Giovanna Milanes Bego Soares ◽

Almir Galvão Vieira Bitencourt ◽

Rubens Chojniak ◽

...

Keyword(s):

Gynecological Cancer ◽

Gynecologic Cancer ◽

Imaging Evaluation ◽

Surgical Specimen ◽

Cervical Cancers ◽

Gynecology And Obstetrics ◽

First Case ◽

Young Subjects ◽

Gynecologic Neoplasms ◽

Case Diagnosis

Summary Endometrial and cervical cancers are the most prevalent gynecologic neoplasms. While endometrial cancer occurs in older women, cervical cancer is more prevalente in young subjects. The most common clinical manifestation in these two gynecological cancers is vaginal bleeding. In the first case, diagnosis is made based on histological and imaging evaluation of the endometrium, while cervical cancers are diagnosed clinically, according to the International Federation of Gynecology and Obstetrics (FIGO). The authors present a case of synchronous gynecological cancer of the endometrium and cervix diagnosed during staging on MRI and confirmed by histological analysis of the surgical specimen.

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