IJGC Podcast

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.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Benoit You to discuss KELIM validation. Dr. You is a French medical oncologist at Lyon University Hospital, specialized in gynecological cancers, and the head of the drug development program of his institution (CITOHL-EPSILYON). Morever, he is the Director of a university research team involved in pharmacokinetics, and modeling analyses of the kinetics of serum tumor markers (EA 3738 CICLY). He is an active member of the French GINECO group, of the European ENGOT group, and of the international GCIG group.

Highlights:

- KELIM is the modeled CA-125 decline rate during the first 3 cycles of adjuvant or neo-adjuvant chemotherapy in first-line setting

- It is a pragmatic indicator of the tumor intrinsic chemosensitivity, easily calculable online on https://www.biomarker-kinetics.org

- KELIM is helpful to surgeons to anticipate the feasibility/complexity of complete interval debulking surgery after neo-adjuvant chemotherapy

- The analyses of ICON-7 and GOG-0218 trial datasets reproducibly showed that only the patients with unfavorable KELIM score - KELIM may be a complementary tool to HRD status to select the best maintenance treatment in first-line setting, especially in patients with HRP cancer : PARP inhibitor expected to be effective in the case of favorable KELIM score ≥ 1.0 ; bevacizumab expected to be effective in the case of unfavorable KELIM score

In this episode of the IJGC podcast, Editor-in-Chief, Dr. Pedro Ramirez, is joined by Drs. Vandré Carneiro and Glauco Baiocchi to discuss the LESSER trial. Dr. Carneiro is the head of the Department of Gynecologic Oncology at the Instituto de Medicina Integral Professor Fernando Figueira (IMIP). He is also Director of the Department of the Hereditary Cancer Program of Hospital de Cancer de Pernambuco. Dr. Baiocchi is the head of the Department of Gynecologic Oncology at the AC Camargo Cancer Center. He is also the president of the Brazilian Gynecologic Oncology Group – EVA Group.

Highlights:

- Hysterectomy is safe and potentially non-inferior to modified radical hysterectomy in early-stage cervical cancer.

- The LESSER supports simple hysterectomy as a substitute for radical hysterectomy in patients with cervical cancer ≤2 cm.

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.

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.

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.

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.

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.

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.