State of the Science
- The ovarian cancer treatment landscape has transformed dramatically in the front-line setting in the past several years. A quarter of a century ago, platinum/taxane adjuvant chemotherapy was established as the new standard of care . Various additions to and adaptations of this backbone were studied including intraperitoneal (IP) chemotherapy, substitution of taxanes with other novel chemotherapeutics, dose-dense administration, and adding novel biologics including bevacizumab to platinum/taxane.
- Stereotactic body radiotherapy (SBRT) is defined as the delivery of image-guided high-dose conformal radiation, in five or fewer treatments. SBRT is established as a treatment option for select disease sites (lung, prostate, pancreas, hepatocellular), and has recently emerged as a promising treatment option in the setting of oligometasatic disease. Retrospective evidence supporting the utility of SBRT in gynecologic malignancies continues to grow however, practice patterns are widely variable .
- Interest in intraperitoneal (IP)-based therapies for epithelial ovarian cancer (EOC) has grown over the past decade. Yet despite multiple theoretical and clinical advantages, IP therapy has not been widely adopted in the U.S. Recently, support for hyperthermic intraperitoneal chemotherapy (HIPEC) has increased. There have been numerous retrospective studies and meta-analyses that support the use of HIPEC in ovarian cancer [1–5]. Further optimism for HIPEC was based on the recent results of a phase III trial [5–9], but significant criticisms have been noted over the use of HIPEC [10–13].
- In July 2019, the NRG Oncology Group held a Summer Symposium in conjunction with its Semi-Annual Meeting entitled “Uterine Sarcomas and Carcinosarcomas: From pathology to practice.” Invited faculty included experts in medical oncology, gynecologic oncology, radiation oncology, pathology, and radiology. Herein we summarize the presentations to guide practice surrounding uterine sarcomas.
- With rapid advancements in cancer therapy, reproductive age women are benefitting from overall improved survival rates . Invasive cancer occurs in approximately 1–2% of this population, with current five-year survival rates in the United States approaching 83% . Challenges remain in managing late effects of cancer therapy, including infertility and premature ovarian insufficiency (POI) . Women need timely reproductive-risk counseling and referrals to reproductive medicine specialists for consideration of fertility preservation (FP) prior to initiating cancer treatment, if desired, to increase their chance of having a child in the future.
- While surgery combined with systemic chemotherapy has remained the foundation of ovarian cancer treatment, the scope, timing, and overall philosophy surrounding surgical debulking has continued to evolve. There is abundant controversy regarding certain aspects of ovarian cancer management, including the role of neoadjuvant chemotherapy (NACT) and the timing of cytoreductive surgery. Over the past 3 decades, however, one factor has remained unchanged: volume of residual disease after debulking surgery is a strong prognostic factor in ovarian cancer, reinforcing the importance and relevance of surgical effort in the care of these patients.
- The idea that a mutation in a single gene could lead to a high risk of breast or ovarian cancer used to be a radical idea. It was not until 1990 that Dr. Mary Claire King and her team localized a gene for hereditary breast cancer to chromosome 17q21 , which she named BRCA1. This discovery set off a race involving multiple research labs around the globe to clone and sequence the gene, ultimately ending in 1994 when a team led by Mark Skolnick became the first to do so [2,3]. Skolnick went on to found Myriad genetics, which then acquired a patent for the sequence of BRCA1, followed shortly the next year with a patent for BRCA2.
- Upon ligand binding, the estrogen (ER) and progesterone receptors (PR) dissociate from chaperone proteins, dimerize, translocate to the nucleus and bind to specific chromatin sites [1,2] enhancing or repressing transcription in hormone dependent tissues. ER and PR are abundantly expressed in the female reproductive tract and mammary gland [3,4] and their expression levels and interaction with co-regulators dictate the robustness of signals, the specificity and context dependent actions in different tissues .
- Since the introduction of the human papillomavirus (HPV) vaccine in 2006, the evidence regarding its efficacy and safety has continued to highlight its importance in cancer prevention. Despite the clear benefits of vaccination, patient perception, public health policy, and changing vaccine availability have impacted vaccine uptake in the United States. Moreover, the vaccination landscape has changed dramatically over the last several years due in large part to the release of a nine-valent HPV (9vHPV) vaccine in 2014, revisions to ACIP guidelines for vaccine dosing, and changes in state-level policies.