Explore every episode of the podcast IJGC Podcast

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Francesco Fanfani to discuss secondary cytoreductive surgery in endometrial cancer. Dr. Francesco Fanfani serves as an associate professor in gynecologic oncology at Fondazione Policlinico Universitario Agostino Gemelli, IRCCS in Rome, Italy.

Highlights:

• Secondary cytoreductive surgery with complete gross resection, has the potential to offer significant survival benefits in recurrent endometrial cancer patients.
• Age <65 years, single site recurrence, and nodal or hematogenous recurrence as predictive factors for complete cytoreduction.
• The study’s findings could influence the decision making process in treatment selection, offering valuable insights for future prospective studies and potential impacts on research and clinical practice. 

 

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Domenica Lorusso to discuss  KEYNOTE-A18 Overall Survival Results: Pembrolizumab and Chemoradiotherapy. Dr. Domenica Lorusso, MD, PhD, directs the Gynaecological Oncology Unit at Humanitas Hospital, Milan, and holds a Full Professorship in Obstetrics and Gynaecology at Humanitas University, Rozzano, Milan. She has led/participated in approximately 250 phase I-IV clinical trials. Currently overseeing more than 60 studies as Principal Investigator, Dr. Lorusso also chairs the Clinical Trials Committee of the MITO Group. She serves on the Board of Directors of the GCIG and is an active member of ENGOT, where she chairs the Gynecological Cancer Academy. Additionally, she sits on the Board of Directors of the ESGO. With around 300 international oncology publications and contributions to national and international treatment guidelines, her primary objectives are to ensure optimal patient care, foster clinical research, and advance international collaborations and education in the field.

Highlights: 

• In a phase 3 trial (ENGOT-cx11/GOG-3047/KEYNOTE-A18), pembrolizumab added to chemoradiotherapy significantly improved progression-free survival and overall survival for patients with locally advanced, high-risk cervical cancer.
• Patient Group: 1060 patients with FIGO 2014 stage IB2–IVA cervical cancer from 30 countries were randomized to receive pembrolizumab with chemoradiotherapy or placebo with chemoradiotherapy.
• Overall Survival: At a median follow-up of 29.9 months, the 36-month overall survival rate was 82.6% in the pembrolizumab group versus 74.8% in the placebo group, with a hazard ratio for death of 0.67 (95% CI 0.50–0.90; p=0.0040).
• Safety Profile: Grade 3 or higher adverse events were reported in 78% of pembrolizumab-treated patients versus 70% in the placebo group, with higher rates of potentially immune-mediated adverse events in the pembrolizumab group (39% vs. 17%).
• Conclusion: These findings confirm pembrolizumab plus chemoradiotherapy as an effective and potentially new standard of care for locally advanced cervical cancer.

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

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 Early Career Editorial Board. Highlights: - Women with early-stage cervical cancer treated with primary radical hysterectomy had improved disease free survival if treated in hospitals with a higher number of radical hysterectomies per year. - Surgical volume of centers represented an independent prognostic factor affecting disease-free survival.

- Increasing number of radical hysterectomies performed in each center every year was associated with improved disease-free survival.

In this episode of the IJGC podcast, Editor-in-Chief, Dr. Pedro Ramirez, is joined by Drs. Ainhoa Madariaga and Robert Coleman, two of the Guest Editors for this month’s special issue entitled “Novel Therapies Leading to a New Landscape in Gynecologic Tumors”. Dr. Madariaga is a Medical Oncologist in the Gynecologic Cancer Unit at 12 de Octubre University Hospital in Madrid, Spain. She is the chair of the Young and Early Career Investigator - EORTC Gynecological Cancer Group. Her research interests include patient reported outcomes and drug development. Dr. Coleman is a Gynecologic Oncologist and Chief Medical Officer at Sarah Cannon Research Institute (SCRI) in Nashville, TN. His research interests include drug development, clinical trial design and global medical education in gynecologic oncology. Highlights: - The alignment of cancer biology and novel treatment approaches are significantly extending the lives of patients with gynecologic malignancies, particularly with agents such as antibody drug conjugates, immunotherapy, and targeted agents. - The evolving therapeutic landscape is escalating the need for a clearer understanding of how precision medicine can most efficiently be implemented. - Emergence of drug resistance provides new challenges and opportunities through creative and strategic investigation of novel treatment and combinations. - Advances in testing platforms in bringing genomic testing to the global audience.

- Clinical trial interpretation requires critical evaluation of analytical primary and hypothesis-generating secondary endpoints – strategies to make appropriate inference is key to clinical trial design.

In this episode of the IJGC podcast, Editor-in-Chief, Dr. Pedro Ramirez, is joined by Dr. Robert Coleman. Dr. Coleman is a Gynecologic Oncologist and Chief Medical Officer at Sarah Cannon Research Institute (SCRI) in Nashville, TN. His research interests include drug development, clinical trial design and global medical education in gynecologic oncology. Highlights: - Strong mentorship is vital to personal and academic development. However, it is a two-way street. True synergy will come from bilateral engagement. - Remember your clinic is your “laboratory” – keep a keen eye for clinical relationships, build hypotheses, and practice the exercise of how to best test it. Even in resource-constrained situations, the process of discovery and hypothesis testing will arm one to be a better investigator and to most appropriately interrogate the literature.

- A strong balance between personal and professional responsibilities will provide the environment for sustainability – this is the long game!

In this episode of the IJGC podcast, Editor-in-Chief, Dr. Pedro Ramirez, is joined by Dr. David M. Gershenson to discuss updates on germ cell tumors. Dr. Gershenson is Professor and former Chair of the Department of Gynecologic Oncology and Reproductive Medicine at The University of Texas MD Anderson Cancer Center. His major focus is on the clinical and translational research or rare ovarian cancers. Highlights: - The treatment of malignant ovarian germ cell tumor has evolved over the last 5 decades to represent one of our most remarkable success stories, with cure in 95+% of patients with stage I/II and approximately 75% of patients with stage III/IV. - AGCT1531 is a very important trial, which, if positive, will reduce toxicity by extending surveillance to patients with stage IA or IB malignant ovarian germ cell tumors, including grade 2 and 3 immature teratomas, yolk sac tumors, and non-gestational choriocarcinomas and will result in the substitution of carboplatin for cisplatin in the regimen for treatment of stage IC-III. - Fertility-sparing surgery is possible in the majority of young patients with malignant ovarian germ cell tumor, related to the following: a) 95% are confined to one ovary ; b) approximately 2/3s are stage I; and c) most patients are in their teenage years, 20s, and 30s and have not completed childbearing. - Major controversies differentiating the treatment of children and adults by pediatric oncologists/pediatric surgeons and gynecologic oncologists, respectively, include the extent of surgical staging and the role of postoperative chemotherapy in patients with pure immature teratoma. - For patients with malignant ovarian germ cell tumors who recur following primary therapy, BEP is recommended for those who have been treated with surgery alone. For those who have previously received BEP, standard management generally includes high-dose chemotherapy with stem cell rescue.

- Aspects of management of malignant ovarian germ cell tumors that require further study include the role of neoadjuvant chemotherapy and the role of secondary cytoreductive surgery.

In this 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.

In this episode of the IJGC podcast, Editor-in-Chief, Dr. Pedro Ramirez, is joined by Professor Giovanni Scambia and Dr. Carmine Conte to discuss mildly invasive surgery in ovarian cancer. Prof. Scambia is the Director of the Gynecologic Oncology Unit and the Scientific Director of Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome, Italy. He is Full Professor of Obstetrics and Gynaecology, at Catholic University in Rome, and Member of Consiglio Superiore di Sanità, Ministry of Health Italy and Vice President 1st Section of Consiglio Superiore di Sanità. He is President Elect of E.S.G.E. (European Society for Gynaecological Endoscopy), and Past President of the Italian Society of Obstetrics and Gynecology (S.I.G.O.). Prof. Scambia is specialized in gynaecological cancer treatment and research. He has studied and developed innovative surgical approaches for the cure of gynecological cancers and has been invited professor in several academic hospitals both in Europe and outside Europe, and he is considered an opinion leader in the field of gynecologic oncology. Dr. Carmine Conte works at the Gynecologic Oncology Unit at Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome, Italy. He got the ESGO Fellowship diploma and is recognized as a certified European Gynaecological Oncologist. Dr. Conte is a surgeon and researcher with special interest in minimally invasive surgery (laparoscopy and robotic) to treat cancerous and noncancerous diseases of the female reproductive system. Highlights: - The patients with oligometastatic recurrent disease had a higher likelihood of minimally invasive secondary cytoreductive surgery. - Lymphnodal recurrences can be easily approached by MIS. - Propensity-matched analysis showed no differences in survival between the MIS and open groups, with a higher rate of overall and severe early complications in the open group. - Diagnostic laparoscopy and PET/CT scan should be considered complementary because of the potential of each one to identify a different disease setting.

- A diagnostic laparoscopy before secondary cytoreductive surgery may prevent unnecessary laparotomies.

In this episode of the IJGC Podcast, Editorial Fellows Andrea Rosati and Anisa Mburu discuss the contents of the January issue of IJGC.

In this episode of the IJGC podcast, Editor-in-Chief, Dr. Pedro Ramirez, is joined by Professors Jacobus Pfisterer and Philipp Harter to discuss prolonged maintenance with bevacizumab. Prof. Philipp Harter is the director of the Department of Gynecology & Gynecologic Oncology at Kliniken Essen-Mitte in Essen, Germany and the chair of the AGO Study Group. Prof. Jacobus Pfisterer is Director of the Gynecologic Oncology Center in Kiel Germany and former chair of the AGO Study Group. Highlights: - 30-month bevacizumb maintenance does not improve progression-free survival nor overall survival in advanced ovarian cancer. - 30-month bevacizumb maintenance is associated with more adverse events compared to 15 months.

- 15-month bevacizumb maintenance remains standard of care.

In this episode of the IJGC podcast, Editor-in-Chief, Dr. Pedro Ramirez, is joined by Dr. Elvio Silva to discuss precursors of ovarian cancer. Dr. Silva received a medical degree from the Universidad de La Plata and has been a faculty member at M.D. Anderson Cancer Center since 1980. He had pathology residences in Buenos Aires, Argentina, and University of Toronto, Canada and is the former President of the International Society of Gynecological Pathologists. Highlights: - Most ovarian serous tumors originate in the ovarian stroma. - Ovarian serous tumors originate in the epithelium of inclusion cysts or in epithelial areas that appear in the stroma due to mesenchymal-epithelial transition.

- Mesenchymal-epithelial transition in serous tumors mimics the development of the Mullerian duct from the celomic mesenchyma.

In this 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 - Black patients were significantly less likely to receive estrogen replacement therapy than White patients.

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.

In this episode of the IJGC podcast, Editor-in-Chief, Dr. Pedro Ramirez, is joined by Dr. Anil K. Sood to discuss novel high-grade serous ovarian morphologic classification. Dr. Sood is a Professor in the Department of Gynecologic Oncology and Reproductive Medicine at the UT MD Anderson Cancer Center. He is Co-Director of the multi-disciplinary Blanton-Davis Ovarian Cancer Research Program and co-leads the Ovarian Cancer Moonshot Program. He is an elected member of the American Society for Clinical Investigation (ASCI), the Association of American Physicians (AAP), and the National Academy of Medicine (NAM). Highlights: - High grade serous ovarian cancer (HGSOC) could be classified into two gross morphologic subtypes. - Type I and type II morphologic subtypes differed with respect to clinical outcomes.

- The two morphologic subtypes also differed with regard to transcriptomic, proteomic, and metabolomic profiles.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Lauren Prescott to discuss the impact of transfusions on outcomes in ovarian cancer. Dr. Prescott received her undergraduate degree from Georgetown University and went on study at the National Institutes of Health for two years. She then completed medical school at Georgetown University, residency in Obstetrics and Gynecology at Dartmouth Hitchcock Medical Center, and fellowship in Gynecologic Oncology at MD Anderson Cancer Center. She has been at Vanderbilt University since 2017. Dr. Prescott's research interests include measuring and evaluating surgical and oncologic outcomes and improving the quality of health care delivery through implementation of evidence-based medicine. Dr. Prescott leads the Vanderbilt Enhanced Recovery After Surgery Program for patients undergoing gynecologic surgery. Highlights: - Perioperative blood transfusions in ovarian cancer is common with 53% of patients in our study having received a transfusion - Blood transfusions were not associated with negative impact on progression-free survival or overall survival

- However, blood transfusions were associated with increased peri-operative morbidity without improvements in quality of life

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez, is joined by Professor Christina Fotopoulou. Professor Fotopoulou works at the Department of Surgery and Cancer at Imperial College London, UK. She is an elected ESGO council member and Chair of the ESGO guidelines committee. Highlights: - Early support from mentors and "giants" in the field, national and international networking and early focusing/specialization in the field of interest are keys to success - Try to turn your weaknesses and failures to learning points and opportunities to make you stronger

- Hard work, kindness and caring for patients, team spirit, professionalism and dedication are the main keys of success next to any talent and luck that anyone might be fortunate enough to have

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez, is joined by Professor Andrea du Bois. Prof du Bois completed his medical degree in 1987 at the University of Freiburg, Germany. He subsequently trained in general surgery at Krankenhaus Wolfach Personalwohnheim and gynaecology and obstetrics at the University of Freiburg, leading to his registration as Fellow for Gynaecology and Obstetrics in 1993. In 1993, Prof. du Bois became a Consultant in the Department of Gynaecology and Obstetrics at St. Vincentius-Kliniken, Karlsruhe. He then served as Director of the Department of Gynaecology and Gynaecologic Oncology, Horst-Schmidt-Kliniken, Wiesbaden (1999-2010) before taking up his current roles as Director of the Department of Gynaecology and Gynaecologic Oncology at Kliniken Essen-Mitte, and Associate Professor at Johannes Gutenberg University of Mainz, Germany. Prof. du Bois has been the Principal Investigator of several pivotal and practice-changing international clinical trials in gynaecological oncology. He founded the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) Study Group in 1993 and co-founded the European Network of Gynaecological Oncological Trial groups (ENGOT) in 2007. He has previously been a member of the German Guideline Committee for guidelines in breast, cervical, and ovarian cancer, Chairman of the German quality assurance programme for ovarian cancer (QS-OVAR), and member of the Gynecological Cancer InterGroup (GCIG) executive board and European Society of Gynaecological Oncology (ESGO) council. Prof. du Bois has been Chairman and a member of the Scientific Committee of the Ovarian Cancer Consensus Conference of the GCIG, and served as a member of the Scientific Committee of the 1st European Society of Medical Oncology (ESMO)-ESGO Ovarian Cancer Consensus Conference 2018. Prof. du Bois is a member of the American Society of Clinical Oncology (ASCO), ESGO, International Gynecologic Cancer Society (ISGC), German Cancer Society, and AGO. He has authored more than 500 publications with more than 33,500 citations, and has a Google Scholar h index of 86.

Prof. du Bois has received multiple honours and awards in recognition for his work, including the Arthur Walpole Award (German Cancer Society, 2006), Ernst Wertheim Award (Austrian Society of Gynecologic Oncology, 2006), MD Anderson Madrid Lifetime Award (2016), Wilhelm-Warner Prize for Cancer Research (2019), German Cancer Prize (Deutsche Krebsgesellschaft, 2020) and honorary membership of the German Society for Gynecology and Obstetrics (2020); 2021 he received the ESGO Lifetime Achievement Award (European Society of Gynaecological Oncology).

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez, is joined by Dr. Anna Fagotti. Dr. Fagotti is the director of the ovarian cancer unit at the A. Gemelli IRCCS University Hospital Foundation, ESGO President Elect and member of the ESGO Executive Committee, and Editor of the International Journal of Gynecological Cancer. Highlights: -Always practice your skills if you want to excel in minimally invasive surgery: Practice makes perfect. -The journey is long for a gynecologic oncologist. We can’t foresee the future and plans might have to be adjusted along the way, so try to be flexible on what you have beside you. Try to answer the relevant clinical questions. Don’t create a question just to answer.

-There can be difficulties along the way, but look forward and focus on your aim and don’t get stopped by obstacles. Remember to try to enjoy everything.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez, is joined by Dr. Jorge Hoegl to discuss peritoneal carcinomatosis after minimally invasive surgery in cervical cancer. Dr. Jorge Hoegl is an early career gynecologic oncologist at the Department of Obstetrics and Gynecology at the General Hospital of the East “Dr. Domingo Luciani” in Caracas, Venezuela. Highlights: -Peritoneal carcinomatosis represented more than 15% of all recurrences, with a recurrence rate of 22.2% in minimally invasive surgery compared to 8.8%. -Peritoneal carcinomatosis has been frequently grouped within distant recurrences and perhaps this made it not such a notorious fact.

-Peritoneal carcinomatosis does not appear to be an unusual recurrence pattern associated with cervical cancer and it should be reported separately.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez, is joined by Dr. Félix Boria to discuss the validation of ESGO quality indicators for cervical cancer. Mr. Boria is an attending physician of the gynecologic oncology division at the University of Navarra (Madrid, Spain) under the mentorship of Dr. Luis Chiva. He is currently finishing his PhD at Universidad Autonoma de Madrid about PET/CT and advanced ovarian cancer. Highlights: - Women who were operated on centers with high compliance of quality indicators had significant lower risk of relapse (HR, 0.39; 95% CI, 0.25 to 0.61; p- The rate of adjuvant treatment in Europe is surprisingly high, especially in low compliance centers (48%). Future investigations should try to address if we are overtreating patients with cervical cancer.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Ilaria Betella and Francesco Multinu. Dr. Betella is an attending in the Department of Gynecologic Surgery at the European Institute of Oncology (IEO) in Milan. Her research focuses on molecular classification of endometrial cancer and on hereditary gynecologic cancer syndromes. Dr. Multinu is a gynecologic oncologist at the European Institute of Oncology (IEO) in Milan as well as a research collaborator in the Department of Obstetrics and Gynecology, Division of Gynecologic Surgery at the Mayo Clinic in Rochester, Minnesota. His special research interests include surgical and postoperative treatment of endometrial cancer. Highlights: - There is evidence that the new molecular classification will be the future in the management of endometrial cancer. - The implementation of molecular analysis allows oncologists to reallocate to a different risk class 6.8% of endometrial cancers that otherwise would have been misclassified and consequently undertreated or overtreated. - The interpretation of molecular classification requires a validated hierarchical algorithm, for which POLE analysis is essential: Even though POLE testing has not been implemented in many institutions, there is no way to use part of the molecular analysis and completely escape POLE analysis.

- According to the new algorithm proposed by Dr. Betella et al., POLE analysis could be spared in 67% of patients and reserved only for those in whom the incorporation of the molecular classification could change the risk class attribution and post-operative management.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Paolo Zola to discuss the TOTEM trial. For 20 years, Dr. Zola has been Chair of Gynaecological Oncology in the Department of Surgical Sciences of the University of Turin (Italy). Dr. Zola has conducted a large number of national and international randomized clinical trials in order to optimize the treatments for women diagnosed with gynaecological cancers. He has served as a member of the board of the EORTC Gynaecological Cancer Group and of the ESGO. Dr. Zola chairs the gynaecological cooperative group within the Oncological Network in Piedmont Region, and his research has been reported in more than 400 manuscripts published in peer reviewed literature. Highlights: - To perform the follow up in patients treated for endometrial cancer, the cornerstone is the clinical control. - In low-risk patients, surveillance every 6 months is appropriate. - In high-risk patients a clinical examination every 4 months for 2 years and then every 6 is recommended.

- In addition, our data suggest taking a CT after 12 and 20 months after the primary treatment.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez, is joined by Dr. Dimitrios Nasioudis to discuss ovarian preservation in grade 2 or 3 endometrial cancer. Dr. Nasioudis is a Gynecologic Oncology Fellow at the University of Pennsylvania. His current research focuses on translational therapeutics and population-based research. Highlights: - For premenopausal patients with endometrial cancer, ovarian preservation is not associated with worse oncologic outcomes for those with grade 1 tumors. However, safety of ovarian preservation for grade 2 or 3 tumors is not established. - Ovarian preservation was not associated with worse overall survival for patients with grade 2 or 3 endometrioid tumors.

-Ovarian preservation may be considered for carefully selected patients with grade 2 tumors.

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)

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Jonathan Ledermann to discuss ICON8-Overall Survival. Jonathan Ledermann is a professor of medical oncology and Clinical Director at UCL Cancer Institute specializing in the treatment and research of gynaecological malignancies. He has led several national and international trials on the treatment of ovarian cancer and has played a key role in developing trials of PARP inhibitors in ovarian cancer. He is the ESMO Gynaecological Cancer Practice Guidelines Editor and past Vice President of ESGO. He is a Fellow of the Academy of Medical Sciences and a Senior Investigator for the National Institute of Health Research in the UK. Highlights: - Weekly first-line chemotherapy for ovarian cancer does not improve progression-free or overall survival. - ICON8 was the largest randomized trial exploring weekly paclitaxel or weekly carboplatin and paclitaxel compared to tri-weekly chemotherapy. - There is no evidence to suggest that weekly first-line chemotherapy should be used as part of multimodal treatment of newly diagnosed ovarian cancer.

- The results in a predominately European population differ from a similar Japanese trial, raising the possibility that genetic or pharmacogenomic differences need to be considered when comparing the results of trials in ovarian cancer.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Professor María Kyrgiou to discuss Cervical Conization Dimensions: 2022 Consensus Recommendations. Professor Mara Kyrgiou is a Professor at Imperial College London and a Consultant Surgeon in Gynaecology and Gynaecological Oncology at the West London Gynaecological Cancer Centre, Imperial Healthcare NHS Trust. She is the Head of Section of Gynaecological Oncology at Imperial College London. Her main clinical interest is minimal access and complex gynaecological cancer surgery. Highlights: - Local treatment techniques for cervical pre-invasive and early invasive disease were previously thought to be interchangeable with regards to treatment failure rates and associated with minor and infrequent complications. - The findings of a network metaanalysis (Athanasiou Lancet Oncology 2022) suggest that more aggressive treatments (i.e., CKC, laser conisation) are associated with lower recurrence rates but higher risk for subsequent preterm birth. - The risk of reproductive morbidity is directly associated with the length of the cone. - This paper by ESGO/EFC/IFCPC describes a consensus terminology of the cone dimensions to make studies addressing effectiveness and safety of SIL/CIN treatment comparable and facilitate their use to tailor surveillance and antenatal management. - The 2022 terminology should replace all previous terminologies, which will facilitate communication between clinicians and foster tailored treatment guidelines that balance obstetrical harm against therapeutic effectiveness.

- Universal agreed reporting will further facilitate communications among clinicians and pathologists, promote audit of practice and future research, and improve the quality of future meta-analyses.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Nadeem Abu-Rustum. 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. Highlights: - The journey of being a gynecologic oncologist is incredibly rewarding. - Focus your research on areas that are meaningful to you. - Question traditional surgical principles that you believe can be improved upon.

- Be grateful to all the people who worked with you and helped make you the person you have become.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Jean-Marc Classe and Florence Joly to discuss the CHRONO trial. Dr. Classe is a surgeon and former head of the surgical department of the Institute of Surgical Oncology of Nantes, France. He is a professor in oncology and president of the French Society of Surgical Oncology. Dr. Joly is a medical oncologist and coordinator of gynecological and genito-urinary medical oncology. She is also the head of the clinical research department of Francois Baclesse Comprehensive Cancer Center in Caen, France. She is a professor in medical oncology and a member of both the scientific board of the GINECO intergroup and the GCIG. Highlights: -In patients treated for an advanced ovarian cancer not suitable to primary surgery, the timing of surgery after neoadjuvant chemotherapy (NAC) could depend on chemosensitivity. -When more cycles of NAC are discussed, do not confuse more cycles in order to make the disease suitable to a complete surgery with more cycles in order to perform less surgery. -In cases of patients with a highly chemosensitive advanced ovarian cancer, delaying surgery could reduce surgical morbidity and improve quality of life.

-More cycles of NAC to treat a chemosensitive disease could improve the rate of complete surgery and improve the rate of pathological complete response.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. David Viveros-Carreño and Rene Pareja to discuss Sedlis criteria. Dr. Viveros-Carreño is a Gynecologic Oncologist at Instituto Nacional de Cancerología, Clínica Universitaria Colombia and Clínica Los Nogales 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, an Associate Editor for IJGC, and a member of the board of directors of the International Gynecological Cancer Society (IGCS). He is the author of nine book chapters and more than 70 publications in peer-reviewed journals, and at IGCS 2021 he received an award for Community Advancement in Resource-Limited Settings. Highlights: -There is currently a debate regarding the role of adjuvant therapy for intermediate-risk cervical cancer. -Adjuvant pelvic radiotherapy showed lower risk of recurrence for intermediate-risk cervical cancer in a randomized controlled trial more than 20 years ago. -Preoperative imaging, surgery, pathology, and radiotherapy techniques have changed since the evidence for intermediate risk adjuvant treatments was described. -The risk of recurrence for intermediate risk cervical cancer is probably lower now, and observation could be an option.

-New evidence from two randomized controlled trials (GOG 263 and CERVANTES trials) is expected to change definitions of intermediate risk and adjuvant algorithms.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Dmitriy Zamarin to discuss immune checkpoint inhibitors in ovarian cancer. Dr. Zamarin is a medical oncologist and a translational research director in gynecologic medical oncology at the Memorial Sloan Kettering Cancer Center. His research focuses on development of novel immune therapeutics in gynecologic malignancies and on the mechanisms of immune response to immunotherapy. Highlights: -Immune checkpoint blockade benefits a subset of patients with ovarian cancer, but predictors of such benefit remain unknown. -Patients with ovarian clear cell carcinoma appear to be more likely to derive benefit from immunotherapy, particularly from combined immune checkpoint blockade; however, these patients still constitute only a minority of those with ovarian clear cell carcinoma. -Larger prospective trials of immune checkpoint blockade, including combined immune checkpoint blockade in ovarian clear cell carcinoma, are needed to validate these early observations.

-Biomarkers of response to immunotherapy like PD-L1 expression and tumor mutation burden are of limited value in ovarian cancer, and other molecular and microenvironment biomarkers are needed.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Mario Leitao and Evan Smith to discuss outcomes of low-grade endometrial stromal sarcoma. Dr. Leitao is an attending surgeon and member at Memorial Sloan Kettering Cancer Center as well as a Professor at Weill Cornell Medical College. He serves as the fellowship director at MSKCC as well as the Director of the Minimally Invasive and Robotic Surgery Program. Dr. Smith is a gynecologic oncologist at Woman’s Hospital in Baton Rouge, Louisiana. He also serves as an Assistant Clinical Professor of Gynecologic Oncology with the LSU Health Obstetrics and Gynecology residency program in Baton Rouge. Highlights: -Lymphadenectomy is unnecessary in patients with low-grade endometrial stromal sarcoma (ESS) and clinically normal nodes. -Postoperative therapies do not improve progression-free survival (PFS) or overall survival in low-grade ESS that is completely resected. -FIGO stage is associated with PFS but not disease-specific survival.

-Next generation sequencing is standard for soft tissue sarcomas and should be offered to patients with low-grade ESS.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Professor Bradley J. Monk to discuss the ATHENA-MONO clinical trial. Prof. Monk is an international thought leader and clinical trialist who has developed and advocated for maintenance treatment in newly diagnosed advanced and recurrent ovarian cancer. ATHENA-MONO represents his fifth positive randomized phase 3 trial studying maintenance treatment and adds confidence to this efficacious and tolerable paradigm changing opportunity for all patients regardless of the molecular genotype (allcomers). Highlights: - Maintenance therapy is now the global standard of care in patients with advanced or recurrent epithelial ovarian cancer. This can include a PAPP inhibitor, bevacizumab, or the combination. - Maintenance treatment is efficacious in all molecular subgroups and is tolerable without an impairment in the quality of life.

- Payers acknowledge the value of maintenance treatment as do consensus guidelines.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Devon Abt to discuss SLN mapping in endometrial hyperplasia. Devon is a fourth-year Resident in Obstetrics & Gynecology at Beth Israel Deaconess Medical Center/Harvard Medical School currently applying into Gynecologic Oncology fellowship. Highlights: - Fewer than 30% of patients with preoperative diagnosis of endometrial intraepithelial neoplasia had concurrent endometrial cancer on final pathology. Endometrial stripe ≥20mm was associated with 2 times the risk of concurrent endometrial cancer. - Routine SLND in all patients with preoperative diagnosis of endometrial intraepithelial neoplasia is not cost-effective and would result in overtreatment.

- Endometrial stripe may be a criterion for selectively using a sentinel lymph node algorithm in patients with preoperative diagnosis of endometrial intraepithelial neoplasia who are poor candidates for lymphadenectomy or at institutions where frozen section is not available or reliable.

In this rebroadcasted episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Ainhoa Madariaga to discuss parp inhibitor treatments and adverse events. Dr. Madariaga's article "Manage wisely: poly (ADP-ribose) polymerase inhibitor (PARPi) treatment and adverse events" (ijgc.bmj.com/content/early/2020…8/ijgc-2020-001288), was the Lead Article in the July 2020 issue of IJGC. Dr. Madariaga is a medical oncologist working as a clinical research fellow in the gynecology and drug development program at Princess Margaret Cancer Centre. Her clinical and academic areas of interest are gynecologic cancers and early phase clinical trial design, such as development of drug-repurposing studies, cancer treatment adverse event and patient reported outcomes assessment.

Original release date: July 6, 2021

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.

In this rebroadcasted episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Nicole Concin to discuss the ESGO-ESTRO-ESP Endometrial Cancer Guidelines.

Original release date: January 4, 2021

In this rebroadcasted episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Oliver Zivanovic to discuss updates on role of HIPEC in ovarian cancer. Dr. Zivanovic is a Gynecologic Cancer Surgeon at Memorial Sloan Kettering Cancer Center, with the goal to advance the early detection and treatment of women with gynecologic cancers. His special interests include the treatment of patients with advanced stage ovarian cancer and electronic patient-reported symptom monitoring after cancer surgery.

Original release date: August 30, 2021

In this rebroadcasted episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Kathleen Schmeler to discuss the ConCerv Trial. Dr. Schmeler is the lead author of “ConCerv: a prospective trial of conservative surgery for low-risk early-stage cervical cancer,” which was the Lead Article of IJGC’s October 2021 issue. Dr. Schmeler is a Professor in Gynecologic Oncology at The University of Texas MD Anderson Cancer Center. She provides care to women with gynecologic malignancies including surgery, chemotherapy and preventive services. Dr. Schmeler is also the Executive Director of Global Oncology for the MD Anderson Cancer Network. Her research interest is in cervical cancer prevention and treatment, particularly for resource-constrained countries and medically underserved communities in the US. Original release date: October 4, 2021 Highlights: - The ConCerv trial is the first prospective study of conservative surgery in women with low-risk cervical cancer. It included 14 sites in 9 countries. - Findings from the ConCerv Trial offer prospective data supporting a more conservative approach to low-risk patients, sparing them the early and late morbidity associated with radical procedures. - It will also allow for safer cervical cancer surgery in low- and middle-income countries, where the burden of cervical cancer is highest. - In our study, conservative surgery was associated with a 3.5% recurrence rate in women with low-risk cervical cancer. In addition, the rate of positive lymph nodes was 5%, with lymph node assessment recommended in this low-risk population.

- Further study is needed to determine long term outcomes and optimal pathologic criteria for conservative surgery.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Professor Alejandra Martinez to discuss the Chemotherapy Response Score (CRS) in ovarian cancer. Prof. Martinez has been the Deputy Head of the Surgical Oncology Department at Toulouse University Cancer Center (Institut Universitaire du Cancer de Toulouse) since 2016. She has served as the Director of the ESGO fellowship program of the IUCTO since 2017 and as a professor in oncology since 2021. Highlights: - CRS is an easy and reproductible biomarker that can help to stratify a patient's treatment. - CRS 1-2 is associated with higher tumor load, more extensive surgical procedures, residual tumor after cytoreduction, and early relapse.

- Pathology response measured by the CRS is associated with disease-free and overall survival in patients with stage IIIC/IV treated with neoadjuvant chemotherapy irrespective of the number of cycles.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Robert Coleman and Shannon Westin to discuss updates on overall survival PARP inhibitors. Robert L. Coleman, MD, is a gynecologic oncologist is Houston Texas and serves as SVP and Chief Scientific Officer for US Oncology Research. His primary research interests are in drug development for gynecological cancers and clinical trial management; he has authored more than 350 peer-reviewed publications. Dr. Shannon Westin focuses on developmental therapeutics and the use of biomarkers to predict response and recurrence in gynecologic malignancies. She currently serves as the Director of Early Drug Development and Phase I trials in her department and is a Co-Director of the Ovarian Cancer Moonshot. She is currently the PI or co-PI for greater than 30 novel treatment trials in gynecologic malignancies.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Gillian Hanley to discuss opportunistic salpingectomy for the prevention of ovarian cancer. Gillian Hanley, PhD, is an Associate Professor in the department of Obstetrics & Gynaecology at the University of British Columbia and a Canada Research Chair in Population-based Gynecologic and Perinatal outcomes. She does health services research in gynecology, primarily in the area of ovarian cancer prevention. Highlights: 1. Opportunistic salpingectomy, the removal of fallopian tubes during a hysterectomy with ovarian preservation or instead of tubal ligation, has been recommended as ovarian cancer prevention following evidence that the fallopian tube is the tissue of origin for most high grade serous ovarian cancers. 2. We recently published the first data comparing observed to expected numbers of serous and epithelial ovarian cancers following opportunistic salpingectomy done for the purposes of ovarian cancer prevention in British Columbia, Canada.

3.Our data strongly suggest that opportunistic salpingectomy is effective in preventing serous ovarian cancers. There were 0 serous cancers in the opportunistic salpingectomy, and if they had been arising at the same rate as in the control groups (hysterectomy alone and tubal ligation), we would have expected 5.3. 0 is below the low end of the 95% confidence interval.

In this episode of the IJGC Podcast, Editorial Fellows Katherine Hicks-Courant and Christina Uwins discuss the contents of the June issue of IJGC.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Mario Preti to discuss the ESGO, ISSVD, ECSVD, and EFC consensus statements on pre-invasive vulvar lesions. Dr. Preti received his Specialization in Gynecology and Obstetrics and Specialization in Medical Oncology at the University of Torino. He is Associate Professor at the Department of Surgical Sciences, University of Torino, Italy, and the Immediate Past President of the ISSVD (International Society for the Study of Vulvo-vaginal disease). Dr. Preti is the author of 4 books on vulvo-vaginal diseases, and as of June 2022, he has published 108 papers indexed in Scopus/Pubmed, with 2,014 citations and an H-index of 23. Highlights: Epidemiological data show no decrease in vulvar invasive cancer incidence. This means that accurate diagnosis and treatment of pre-invasive vulvar disease must be improved: these are among the ESGO-ISSVD-ECSVD aims. The two carcinogenic pathways of vulvar squamous neoplasia recognize as precursors two vulvar intraepithelial neoplasia (VIN): HPV-associated squamous intraepithelial lesions (High Grade VIN) and HPV-independent VIN (mainly differentiated VIN). These precursors have different clinical approach, treatment and oncological risk. Their histologic features can be subtle, and the histological diagnosis may be further complicated by coexisting conditions. For differentiated VIN, an excisional procedure must always be adopted. Medical treatment (imiquimod or cidofovir) and ablative treatment can be considered for high grade VIN to preserve anatomy and function. These conservative approaches must be preceded by representative biopsies to exclude invasive disease. Follow up should be modulated according to the risk of recurrence (type of lesion, patient age and immunological conditions, other associated lower genital tract lesions).

Pre-invasive vulvar lesions deserve specific attention because they affect not only functionality and body image, but also psychosexual factors.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Gerda Trutnovsky to discuss the use of imiquimod versus surgery for the treatment of vHSIL. Dr. Trutnovsky studied at the University of Graz/Austria and the University of Sydney/Australia. She works as an associate professor in the Department of Obstetrics and Gynecology at the Medical University of Graz/Austria, with a special interest in vulvar disease. Highlights: This was the first prospective trial of imiquimod versus surgery for the treatment of vulvar high grade squamous intraepithelial lesions (vHSIL). Complete clinical response at 6 months was observed in 80% of patients using imiquimod per-protocol, compared to 79% in women who had one surgical intervention. Imiquimod was used in a slowly escalating dosage scheme up to 3 times a week and reduced in case of side effects – local toxicity was mostly mild to moderate.

Imiquimod is a safe, effective and well accepted alternative to surgery and can be considered a first-line treatment option.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Dimitrios Nasioudis. Dr. Nasioudis is a Gynecologic Oncology Fellow at the University of Pennsylvania. His current research focuses on translational therapeutics and population-based research. Highlights: The utility of surgical staging for patients with locally advanced cervical cancer has not been established. While PET-CT is the most sensitive imaging modality to detect para-aortic metastases, the false negative rate can be as high as 20%. In the United States, surgical staging for locally advanced cervical cancer is rarely performed with a decreasing utilization.

The impact of surgical staging on the oncologic outcomes is not clear.

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.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Andreas Obermair. Dr. Obermair is a gynecological oncologist in Brisbane, Australia, promoting surgery with proven better patient outcomes. Highlights: - Facing and dealing with adversity in life - Goals for making gynecological oncology safer, less invasive, and smarter; ensuring that patients are not scared of treatment; and increasing the effectiveness of treatment

- Exploring novel options of therapy and seeking strategies for newer treatments. Only if we are not satisfied with what we do today can we hope to achieve a better outcome tomorrow.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. David Viveros-Carreño. Dr. Viveros-Carreño is a Gynecologic Oncologist at Instituto Nacional de Cancerología, Clínica Universitaria Colombia and Clínica Los Nogales in Bogotá, Colombia. Highlights: - Fertility-sparing surgery after neoadjuvant chemotherapy in cervical cancer >4 cm is feasible, but the evidence is limited and should be considered as an experimental intervention. - A complete pathological response occurred in 56% of patients.

- At least one pregnancy was achieved in 67% of cases and 60% were pre-term deliveries.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Katherine Hicks-Courant, MD, MSHP. Dr. Hicks-Courant is a fellow in the Division of Gynecologic Oncology at the University of Pennsylvania. She studies the intersection of gynecologic oncology, palliative care and oncology care delivery systems. Highlights: Having a gynecologic rather than a medical oncologist was associated with lower rates of high-intensity end-of-life care. Having a gynecologic oncologist rather than a medical oncologist was associated with higher rates of invasive procedures.

Having a gynecologic oncologist rather than a medical oncologist was associated with higher Medicare spending.