Challenges and controversies in the conservative management of uterine and ovarian cancer

Janda, Monika; McGrath, Shaun; Obermair, Andreas

doi:10.1016/j.bpobgyn.2018.08.004

Cited by 13 publications

(7 citation statements)

References 83 publications

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“…However, obesity negatively impacts pregnancy rates and lowers the probability of long-term treatment success among women receiving fertility-sparing treatment [ 85 , 86 ]. This remains an ongoing challenge to conservative management of EC, and high-quality data from randomized controlled trials are needed to successfully address this issue [ 87 ].…”

Section: Reproductive and Oncologic Outcomesmentioning

confidence: 99%

Fertility-sparing treatment in early endometrial cancer: current state and future strategies

et al. 2020

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Endometrial cancer (EC) is the fifth most common cancer in women worldwide. Global estimates show rising incidence rates in both developed and developing countries. Most women are diagnosed postmenopausal, but 14–25% of patients are premenopausal and 5% are under 40 years of age. Established risk factors include age and hyperestrogenic status associated with nulliparity, obesity, and metabolic syndrome. Standard treatment for EC, which involves total hysterectomy and bilateral salpingo-oophorectomy, has excellent survival outcomes, particularly for low-grade endometrioid tumors. However, it leads to permanent loss of fertility among women who wish to preserve their reproductive potential. With current trends of reproductive-age women delaying childbearing, rising EC incidence rates, and a growing epidemic of obesity, particularly in developed countries, research on conservative non-surgical treatment approaches remains a top priority. Fertility-sparing treatment predominantly involves the use of oral progestins and levonorgestrel-releasing intrauterine devices, which have been shown to be feasible and safe in women with early stage EC and minimal or no myometrial invasion. However, data on the efficacy and safety of conservative management strategies are primarily based on retrospective studies. Randomized clinical trials in younger women and high-risk obese patients are currently underway. Here, we have presented a comprehensive review of the current literature on conservative, fertility-sparing approaches, defining the optimal candidates and evaluating tumor characteristics, reproductive and oncologic outcomes, and ongoing clinical trials. We have also summarized current guidelines and recommendations based on the published literature.

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Section: Reproductive and Oncologic Outcomesmentioning

confidence: 99%

Fertility-sparing treatment in early endometrial cancer: current state and future strategies

et al. 2020

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“…In 2019, approximately 61,880 new cases of UC and 12,160 deaths from the disease were estimated [75], with the number of UC cases expected to increase in older populations. UC includes endometrial adenocarcinoma (EA) (the most common type), adenosquamous carcinoma, papillary serous carcinoma, and uterine sarcoma [76,77]. Patients in stage I disease have a good prognosis and can be cured with surgery therapy.…”

Section: Risk Factors and Clinical Featuresmentioning

confidence: 99%

The Latest Findings of PD-1/PD-L1 Inhibitor Application in Gynecologic Cancers

Kooshkaki

Derakhshani

Safarpour

et al. 2020

IJMS

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Gynecologic cancers account for approximately 11% of the newly diagnosed cancers in women in the United States and for 18% globally. The presence of tumor-infiltrating lymphocytes (TILs) influences the clinical outcome of cancer patients and immune checkpoint inhibitors (ICIs), including anti programmed cell death protein-1 (anti-PD-1), anti-programmed death-ligand 1 (anti-PD-L1), and anticytotoxic T-lymphocyte antigen 4 (anti-CTLA-4), which have been approved for treating different types of malignancies. Antibodies targeting the PD-1/PD-L1 checkpoint have shown dynamic and durable tumor regressions, suggesting a rebalancing of the host–tumor interaction. There are several the US food and drug administration (FDA)-approved ICIs targeting PD-1, including pembrolizumab and nivolumab, as well as those targeting PD-L1, including avelumab, atezolizumab, and durvalumab for melanoma, renal cell cancer, colorectal cancer, head and neck cancer, cervix cancer, urothelial cancer, and lung cancer. Current pre-clinical and clinical studies assessing PD-1/PD-L1 inhibitors in several gynecologic cancers have reported significant antitumor activity. In this review, we investigate pre-clinical and clinical studies that describe the safety and efficacy of anti-PD-1/PD-L1 antibodies, with a particular focus on ongoing clinical trials, analyzing the oncological outcome and adverse effects of ICIs in gynecologic cancers.

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Section: Ovarian Cancer Suspected Early-stage Ovarian Cancermentioning

confidence: 99%

“…Adenexal masses suspected to be cancerous should undergo immediate staging laparotomy as they constitute only 10%-15% of all ovarian cancer cases [11] . Primarily resected ovarian cancer mandates adjuvant therapy as per the guidelines, except for grade 1 or 2 stage I disease [11] . In the current situation of the COVID-19 pandemic, single-agent carboplatin can be considered a suitable option as there is limited evidence of benefit of combination therapy in early stage ovarian cancer.…”

Section: Ovarian Cancer Suspected Early-stage Ovarian Cancermentioning

confidence: 99%

Impact of COVID-19 on gynecological cancer management

Rani¹,

Agarwal²,

Rahul³

et al. 2020

Int. J. Clin. Obstet. Gynaecol.

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The coronavirus disease 2019 (COVID-19) pandemic has affected every aspect of health care, including the delivery of standard care to patients afflicted with cancer. Patients with cancer may be at higher risk for COVID 19 morbidity or mortality than general population. Whether one can delay cancer procedures remains an ethical issue and there is not much clarity on management in these critical situation. Currently available literature on impact of COVID-19 on gynecological cancer management was reviewed. COVID-19 poses more risks to cancer patients especially who are older and have medical co-morbidities. On the other hand, gynecological malignancies require radical surgical procedures, complex prolonged radiation techniques, and myelosuppressive chemotherapy which make these patients more susceptible for COVID-19. A virtual multidisciplinary tumour board should conducted to plan their management. To limit the hospital visit, teleconsultation should be used to advise patients for pretherapy evaluation and post therapy follow up. Surgical decision making may be categories into three categories: patients with low, intermediate, or high acuity. Assessment of the severity of disease, co-morbidites, and logistic challenges along with COVID-19 burden in their area are important variables for individualized decision making. Safety of healthcare personnel needs to be ensured at the same time. Currently available evidence is limited by small sample size and unfamiliarity with the full impact of this pandemic on cancer. However, the ongoing crisis will strain resources needed to deliver cancer care in the future.

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Challenges and controversies in the conservative management of uterine and ovarian cancer

Cited by 13 publications

References 83 publications

Fertility-sparing treatment in early endometrial cancer: current state and future strategies

Fertility-sparing treatment in early endometrial cancer: current state and future strategies

The Latest Findings of PD-1/PD-L1 Inhibitor Application in Gynecologic Cancers

Impact of COVID-19 on gynecological cancer management

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