Highlights on gynaecological cancer

Prof Hannelore Denys, a medical oncologist at the University Hospital Ghent, Belgium, provided a comprehensive overview of critical studies presented at ASCO 2024 in the Gynaecological Cancers session.

The BrUOG 354 trial enrolled 44 patients with extra-renal clear cell carcinomas, which are rare, often chemo-resistant tumours with a poor prognosis originating from the ovarian, endometrial, or cervical tract. This randomised phase two trial included patients with metastatic disease who had undergone at least one previous line of chemotherapy. The patients were treated with nivolumab (Nivo) alone or in combination with ipilimumab (Nivo-Ipi). The combination therapy showed better results, with one-third of the patients achieving stable disease and another third achieving a partial or complete response, indicating an apparent activity of the Nivo-Ipi combo in this tumour type.

The next trial to discuss is the ENGOT-ov34, a phase three trial that enrolled over 500 patients with relapsed ovarian cancer. This trial investigated the addition of atezolizumab to a regimen of non-platinum-based chemotherapy and bevacizumab. Unfortunately, the trial yielded negative results, as adding atezolizumab did not improve outcomes. In this setting, There was no synergy between the anti-VEGF agent bevacizumab and the immunotherapy atezolizumab.

Next, the NRG-GOG-0724 trial focused on cervical cancer, specifically investigating the addition of adjuvant chemotherapy following chemoradiation. The trial yielded negative results, demonstrating that adding carboplatin and paclitaxel after chemoradiation in patients with early-stage high-risk cervical cancer did not improve outcomes. These findings align with the results of the OUTBACK trial, reinforcing the conclusion that this adjuvant chemotherapy approach is not beneficial in this patient population.

Now, let’s switch gears to a surgical trial: the CARACO trial. We know from the LION trial that systematic lymphadenectomy offers no benefit in patients undergoing primary debulking surgery for ovarian cancer. However, whether this applies to patients undergoing interval debulking surgery remained. The CARACO trial aimed to address this question by randomising patients undergoing primary or interval debulking surgery to systematic lymphadenectomy if they did not have suspiciously enlarged lymph nodes. The trial showed no benefit from performing lymphadenectomy. Moreover, lymphadenectomy was associated with increased morbidity and even mortality. The conclusion is clear: systematic lymphadenectomy should not be performed in either primary or interval debulking surgery patients with ovarian cancer.

To conclude this summary, two significant database studies from the US highlight key trends and outcomes in endometrial cancer. The first study shows a strong relationship between rising obesity rates and the incidence of endometrial cancer, particularly among younger patients. The study indicates a dramatic increase in endometrial cancer cases in patients under 30 and under 40 years old, suggesting that we could face a real epidemic of endometrial cancer in the coming decade.

The second study focuses on young patients with low-stage endometrial cancer, comparing fertility-sparing hormone treatments to hysterectomy. For patients under 40, the 10-year survival outcomes showed no difference between the two treatments. However, for patients aged 40 to 49, a worse outcome was associated with progestins compared to hysterectomy. The authors recommend careful patient selection and monitoring for fertility-sparing treatments, advising particular caution for patients between 40 and 49 years old, given the lack of randomized clinical trials.