IJGC Podcast BMJ Group

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Ramez N. Eskander to discuss NRG-018 pembrolizumab and chemotherapy in uterine cancer. Dr. Eskander is a gynecologic oncologist who specializes in the comprehensive management of female reproductive system cancers, including ovarian, uterine, cervical, vulvar and vaginal cancer. His expertise includes diagnostic and therapeutic procedures, including minimally invasive (robotic) surgery, chemotherapy and novel drugs.

Highlights:

• NRG-GY018 showed that the addition of pembrolizumab to chemotherapy, followed by maintenance pembrolizumab, resulted in a 70% lower risk of disease progression or death in patients in the dMMR cohort and a 46% lower risk in the pMMR cohort than in the placebo group.

• These data suggest that the incorporation of immunotherapy into the first-line treatment of advanced or recurrent endometrial cancer improves oncologic outcomes, regardless of MMR status or histologic findings.

• Previous monotherapy drugs against PD-1 and PD-L1 in recurrent or metastatic pMMR endometrial cancer resulted in only modest improvement.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Carien Creutzberg, Nanda Horeweg, and Alexandra Leary to discuss the RAINBO trials. Carien Creutzberg is Professor of Radiation Oncology at Leiden University Medical Center, the Netherlands. She specializes in research and treatment of gynecological cancers and has been the initiator and principal investigator of the four PORTEC trials and the TransPORTEC consortium. She is current chair of the GCIG Endometrial Cancer Committee and past Council member of ESGO and IGCS. Nanda Horeweg is senior researcher at the department of Radiation Oncology of Leiden University Medical Center, the Netherlands. She is one of the principal investigators of the PORTEC team and the international coordinator of the RAINBO program of clinical trials. Alexandra Leary, MD, PhD, is a medical oncologist specializing in gynecological cancers at Gustave Roussy Cancer Center in France. She is the CI for the RAINBO-RED trial and member of the TransPORTEC Consortium. She is current chair of the GCIG Phase II committee, gyne track chair for ESMO Asia, and past gyne track chair for ESMO.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Rene Pareja to discuss recent the cervical cancer management updates. Dr. Pareja is a gynecologist-oncologist at Astorga Oncology Clinic in Medellín and the National Cancer Institute in Bogotá, Colombia. He is a reviewer for more than 20 specialty journals and is an Associate Editor for IJGC. He is the author of ten book chapters and more than 80 publications in peer-reviewed journals, and at IGCS 2021 he received an award for Community Advancement in Resource-Limited Settings.

Highlights:
- There is controversy in offering minimally invasive approaches to women with early-stage cervical cancer and tumors less than 2 cm.
- The role of surgical staging remains controversial because guidelines still recommend it, despite evidence of a negative prospective randomized controlled trial.
- Intermediate risk factors after a radical hysterectomy need to be re-evaluated in a very well designed prospective randomized trial, with modern radiotherapy techniques and updated inclusion criteria.

In this episode of the IJGC podcast, Editor-in-Chief, Dr. Pedro Ramirez, is joined by Dr. Giuseppe Caruso discuss post-PARP myeloid neoplasms. Dr. Caruso is a fifth-year resident in Obstetrics and Gynecology and a first-year fellow of the PhD in “Network Oncology and Precision Medicine” at Sapienza University of Rome in Italy. Over the past year, he has been attending the Department of Gynecologic Oncology at the European Institution of Oncology (Milan) under the mentorship of Professor Nicoletta Colombo and has now started his research fellowship period at Mayo Clinic (Rochester) under the supervision of Professor William Cliby. His main interest areas are gynecologic oncology, personalized oncology, and clinical research.

Highlights:

- Myeloid neoplasms post PARPi in patients with ovarian cancer are gradually emerging as life-threatening late toxicities and should not be underestimated.

- The first two years of PARPi exposure are the critical window of onset and persistent cytopenia has been recognized as an early warning sign.

- Active surveillance, differential diagnosis, and prompt hematological referral are crucial.

- PARPi are recommended in the first line also to improve the risk-benefit ratio.

- PARPi should be used cautiously in patients with a higher baseline risk and/or those who are less likely to have a significant benefit.

In this episode of the IJGC podcast, Editor-in-Chief, Dr. Pedro Ramirez, is joined by Dr. David Cibula to discuss the 2023 ESGO-ESTRO-ESP Guidelines for Cervical Cancer. Dr. Cibula is the Chair of the Department of Obstetrics and Gynecology at the General Faculty Hospital in Prague, Professor at the First Medical Faculty of the Charles University, Chair of the Central and Eastern European Gynaecologic Oncology Group (CEEGOG), member of the Strategic group of the ENGOT (European Network for Gynaecological Oncological Trial Groups) as well as a Former ESGO president.

Highlights:

- Multidisciplinary clinical practice guidelines developed jointly by ESGO/ESTRO/ESP in the field of gynaecological oncology, radiation oncology and pathology.

- Guidelines cover the management of all stages of cervical cancer, including separate sections dedicated to pathology reporting and management in pregnancy.

- The guidelines include recommendations, algorithms, and summaries of recent evidence published as supplements.

In this episode of the IJGC podcast, Editor-in-Chief, Dr. Pedro Ramirez, is joined by Dr. Giuseppe Caruso and Prof. Nicoletta Colombo to discuss updates on PARPi in ovarian cancer. Dr. Caruso is a fifth-year resident in Obstetrics and Gynecology and a first-year fellow of the PhD in “Network Oncology and Precision Medicine” at the Sapienza University of Rome in Italy. Over the past year, he has been attending the Department of Gynecologic Oncology at the European Institution of Oncology (Milan) and had the huge opportunity to follow the clinical, surgical and research activities of an international center of excellence, under the mentorship of Prof. Nicoletta Colombo and Prof. Giovanni D. Aletti. His main interest areas are gynecologic oncology, personalized oncology, clinical research, and medical writing. Prof. Nicoletta Colombo is Chair of Gynecology Program and Director of the Ovarian Cancer Centre at the European Institute of Oncology in Milan. Principal investigators of several international clinical trials and author of several publications, she was President of ESGO and Chair of the ESMO-ESGO-ESTRO Consensus Conference in endometrial cancer (2015) and the ESMO-ESGO Consensus Conference in ovarian Cancer (2018). In 2020, Prof. Colombo received the IGCS Lifetime Achievement Award in recognition of her work in gynecological oncology.

Highlights:

- PARPi should be preferred in the upfront setting for both efficacy and safety reasons.

- Mutational status and platinum response are key factors for personalizing the maintenance treatment.

- Identifying better predictors of resistance to platinum and PARPi is an unmet need.

- PARPi combinations could become a strategy for overcoming PARPi resistance.

- The best treatment algorithm after PARPi progression needs prospective validation.