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. Alessandro Santin to discuss Sacituzumab Govitecan (TROPiCS—03) in Advanced Endometrial Cancer. Dr. Alessandro D. Santin, a native of Italy, graduated with honors from the University of Brescia, Italy and received his postgraduate training in Obstetrics & Gynecology at the same University. He served a fellowship in Gynecologic Oncology at the University of California, Irvine and an International Fellowship in the Division of Gynecologic Oncology at the University of Arkansas for Medical Sciences, Little Rock, Arkansas. Dr. Santin joined the faculty in the Section of Gynecologic Oncology in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale University as Professor as of July 2008. Dr. Santin has more than 400 original research and peer-reviewed publications including multiple review articles and book chapters and he has written extensively on various topics, including cancer of the ovary, endometrium and cervix as well as on tumor immunology and immunotherapy. Dr. Santin's clinical interests include the use of immunotherapy in ovarian, cervical and endometrial carcinoma patients with disease resistant/refractory to standard treatment, therapeutic vaccines against Human Papillomavirus (HPV) infected genital tumors, and the development of personalized treatment modalities including monoclonal antibodies and antibody-drug-conjugates (ADC) against chemotherapy resistant gynecologic tumors. Highlights: In the TROPiCS-03 trial Sacituzumab Govitecan demonstrated encouraging clinical activity in recurrent endometrial cancer patients in progression after chemotherapy and immune check point inhibitors Sacituzumab Govitecan toxicity profile was manageable with only 5% of patients discontinuing treatment due to TRAEs TROP-2 protein was expressed in over 90% of endometrial cancer patients enrolled in the TROPiCS-03 trial and showed limited correlation with efficacy to Sacituzumab Govitecan

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Rongyu Zang and Yulian Chen to discuss the SOC-1 trial. Dr. Rongyu Zang is the Director of the Department of Gynecologic Oncology, Fudan University Zhongshan Hospital, & Institute for Ovarian Cancer, Fudan University and is the Principal investigator of the SOC-1 and SUNNY trials. Dr. Yulian Chen is an Attending Physician at the Department of Gynecologic Oncology, Fudan University Zhongshan Hospital. Highlights: The SOC-1 trial concluded that in patients with platinum-sensitive, relapsed ovarian cancer, surgery did not increase overall survival in the intention-to-treat population, but resulted in a prolongation of survival after adjustment of crossover. Surgery may provide an obviously higher proportion of long-term relapse-free survivors than chemotherapy alone. An active preoperative evaluation for all patients with platinum-sensitive first relapsed ovarian cancer is suggested in specialized centers.

Nadeem Abu-Rustum bio: 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. Christian Dagher bio: Christian Dagher is a former research fellow at Memorial Sloan Kettering, and current OBGYN resident at the University of Pennsylvania. He holds a master's degree in clinical epidemiology and health-services research from Weill-Cornel. Before moving to the US, he completed an OBGYN residency at the American University of Beirut and is interested in studying survival biomarkers in endometrial cancer. Highlights: The 2023 FIGO staging system for endometrioid endometrial carcinomas included the extent of lymphovascular invasion as a determinant of stage. The new staging system, groups tumors with no lymphovascular space invasion and those with focal invasion (<5 vessels) into one category and upstages those with substantial invasion ( 5 or more vessels). This study aimed to evaluate the relationship between the extent of lymphovascular invasion and oncologic outcomes in patients with stage I endometrioid endometrial cancer. This study is a retrospective analysis of 1555 patients with FIGO 2009 stage I endometrioid endometrial cancer who underwent total hysterectomy and lymph node assessment at two tertiary centers between 2012 and 2019, categorized by the extent of lymphovascular invasion (no, focal, or substantial invasion as defined by the WHO). Key findings showed that both focal and substantial lymphovascular invasion were linked to lower 5-year progression-free survival (68.7% and 70.5% for substantial and focal invasion, respectively, compared to 90.7% for no invasion). This was true even after limiting the analysis to myoinvasive grades 1 and 2. In conclusion, focal and no lymphovascular invasion have different prognostic outcomes and should not be combined into a single category as proposed by the FIGO staging system. Focal and substantial lymphovascular invasion were not associated with distinct prognostic outcome that could support upstaging of the latter.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Luis Chiva to discuss the Elikia project in the Democratic Republic of the Congo. Dr. Luis Chiva is the Head of Gynecology and Obstetrics and Director of Gynecologic Oncology at at Clínica Universidad de Navarra. Highlights: Inspiration: Dr. Luis Chiva began the Elikia project in the DRC in 2016 after seeing the urgent need for cervical cancer screening and maternal health. Screening Approach: The project uses visual inspection with acetic acid, inspired by a successful model from India, to reduce cervical cancer mortality. Team and Challenges: A team of volunteers faces challenges like limited healthcare infrastructure and promoting preventive care. Sustainability: The project relies on donations and grants to remain sustainable. Personal Impact: The work has profoundly influenced Dr. Chiva, renewing his commitment to humanitarian efforts.

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. 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. 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. Robert Coleman to discuss overall survival of SORAYA trial. Dr. Coleman completed his Obstetrics & Gynecology residency at Northwestern University Medical Center in Chicago, Illinois, and completed his fellowship at The University of Texas MD Anderson Cancer Center in 1993. From 1993-1996, he served as Assistant Professor at Creighton University followed by service as Vice-Chairman, Department of Obstetrics and Gynecology at the University of Texas, Southwestern Medical Center. Dr. Coleman joined as Faculty at MD Anderson Cancer center in 2004 and served as Professor and Executive Director for Cancer Network Research, holding the Ann Rife Cox Chair in Gynecology. In March 2020, he joined US Oncology Research (USOR) as Chief Scientific Officer and served briefly as Chief Medical Officer for Sarah Cannon Research Institute (SCRI). He currently serves as Chief Medical officer for Vaniam Group. Dr. Coleman has authored or coauthored over 750 scientific publications, including over 450 peer-reviewed articles, along with numerous book chapters, monographs, invited articles, and textbooks. He was the 2019 APGO-CREOG awardee for Excellence in Teaching. He serves as Vice President of GOG-Foundation, Inc. He served as President of SGO (2015-2016) and is the immediate Past-President of IGCS. He was recently inducted into MJH Life Sciences™ 2020 class of “Giants in Cancer Care®.” Highlights: Mirvetuximab soravtansine (MIRV) is a first-in-class antibody-drug conjugate comprising an FRα-binding antibody, cleavable linker, and maytansinoid DM4, a potent tubulin-targeting agent Early clinical data suggested efficacy in recurrent platinum-resistant ovarian cancer (PROC) prompting a larger trial to confirm both safety and efficacy in patients with PROC In this SORAYA trial MIRV demonstrated clinically meaningful antitumor activity in patients with FRα-high platinum-resistant ovarian cancer with an ORR: 32.4% and a median DOR: 6.9 months Remarkably the median OS was 15 months; 37% patients alive at 24 months Efficacy of MIRV was further evaluated with respect to when it was administered (as first treatment for PROC) and in patients receiving prior bevacizumab. An ORR of 34.8% was documented in the formers, and 31.5% in the latter. The ocular toxicity was new for many treating physicians when the drug first became available. However with mitigating strategies as used in the study the events were predictable, low-grade, and rarely (n=1 patient) led to treatment discontinuation Now with MIRASOL confirming these data and demonstrating efficacy over standard of care for response, PFS, and unprecedently, OS, the agent is a staple of contemporary management.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Mansoor Mirza and Angélica Nogueira Rodrigues to discuss recent updates on endometrial cancer in Latin America. Dr. Mirza is a highly qualified medical oncologist with expertise in Medical and Radiation Oncology, holding multiple degrees and licenses in these fields. He currently serves as the Chief Oncologist at the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Denmark, and holds the position of Medical Director of the Nordic Society of Gynaecologic Oncology-Clinical Trial Unit (NSGO-CTU). Dr. Mirza is actively involved in numerous medical societies, clinical research, and international trial collaborations, and has contributed significantly to the development of clinical protocols and guidelines for the management of various cancers. Dr. Angélica Nogueira-Rodrigues is the Founder of EVA Group, and President-elect of the Brazilian Society of Medical Oncology. She is also a Researcher and Professor at Federal University, MG, Brazil, and Chair of Gynecology at the Latin America Cooperative Oncology Group (LACOG). Highlights: -Detailed epidemiological data on endometrial cancer in Latin America are scant, but GLOBOCAN provides estimates for the incidence of uterine cancer within countries globally. EC is the second gyn cancer in the region, due to the burden of CC which is still the first one. It is estimated that the total number of new cases of uterine cancer in Latin America and the Caribbean will rise from approximately 33,000 in 2020 to an estimated 51,000 in 2040; -The last ten years have been marked by a radical transformation in the understanding of the molecular biology of endometrial cancer, and, including it. or not in FIGO staging, this discussion needs to evolve and be incorporated into clinical practice in Latin America, as it impacts clinical decision, hereditary cancer diagnosis, among others. -The main message for young gynecological oncologists as us to create a future medicine with fewer disparities worldwide is to strive to get access an implement the best for the patient, avoiding protocols adapted for low-income countries which can negatively impact the clinical outcomes.

In this episode of the IJGC Podcast, Editorial Fellows Melis Canturk and Osnat Elyashiv discuss the contents of the July issue of IJGC.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Dimitrios Nasioudis to discuss lymphadenectomy at the time of interval cytoreduction for ovarian cancer. Dimitrios Nasioudis is a gynecologic oncologist at the University of Pennsylvania. Following medical training at the Aristotle University of Thessaloniki, and a research fellowship at the Weill Cornell Medical College he completed his residency and fellowship training at the Hospital of the University of Pennsylvania. His current area of research is translational therapeutics with a focus on low-grade serous ovarian carcinoma. His research interests also include population science and surgical outcomes research. Highlights: The study aimed to evaluate the role of systematic lymphadenectomy during interval cytoreductive surgery in advanced-stage epithelial ovarian carcinoma patients who achieved complete gross resection. An analysis of data from 1060 patients found that those who underwent systematic lymphadenectomy had higher rates of unplanned readmissions and longer hospital stays, with no significant difference in overall survival. Systematic lymphadenectomy was rarely performed and did not provide a survival benefit for these patients.

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Gabriel Levin and Behrouz Zand to discuss ChatGPT-fabricated abstracts in gynecologic oncology. Dr. Gabriel Levin is a gynecologic oncology Fellow at McGill University. His research encompasses population database studies with clinical implication and innovations in medical education and health care. He has published more than 180 peer reviewed original articles.. Dr. Behrouz Zand is a gynecologic oncologist at Houston Methodist Hospital's Neal Cancer Center and Department of Obstetrics and Gynecology, and an assistant professor at Weill Cornell College at Houston Methodist Academic Institute. Specializing in innovative cancer care and clinical trials, he is passionate about integrating AI in medicine, a recent alumnus of the physician program at MIT for AI integration in healthcare. Dr. Zand combines cutting-edge research with compassionate patient care to advance the field. Highlights: Reviewers had difficulty in discriminating ChatGPT-written abstracts. Reviewers correctly identified only 46.3% of ChatGPT-generated abstracts, with human-written abstracts slightly higher at 53.7%. Senior reviewers and those familiar with AI had higher correct identification rates, with senior reviewers at 60% and juniors/residents at 45%. Experience and familiarity with AI were independently associated with higher correct identification rates. ChatGPT assists researchers by generating reviews, summaries, and enhancing writing clarity, but it raises ethical concerns and could diminish human expertise. For non-English speaking authors, it improves writing quality and clarity. In scientific writing, it enhances clarity, summarizes concisely, brainstorms ideas, assists with terminology, and offers data interpretation, augmenting human expertise. ChatGPT and AI in scientific writing can lead to ethical issues, factual inaccuracies, and may eventually diminish human expertise and critical thinking.