Genomic-Based Therapy of Gynecologic Malignancies.

This paper will review the current status of genomic-based therapy of gynecologic malignancies. The routine "standard-of-care" delivery of targeted therapeutics based on the presence of specific molecular biomarkers in the management of the gynecologic malignancies has been delayed compared to the substantial progress made in several other tumor types. However, relatively recently reported and rather robust phase 3 trial data have confirmed a potentially major role for PARP inhibitors as both active treatment and maintenance therapy of advanced ovarian cancer. Further, data demonstrating the presence of a specific molecular phenotype (micro-satellite ( instability high - MSI-H) is a valid biomarker for the potential clinical utility of checkpoint inhibitor immunotherapy has relevance for all gynecologic malignancies, and particularly in the setting of metastatic or recurrent endometrial cancer. CONCLUSIONS: The introduction of PARP inhibitors into the oncology armamentarium has substantially impacted standard-of-care strategies in the management of ovarian cancer. It is anticipated that the results of ongoing and future trials will further define the role of genomic-based therapy in ovarian cancer and other gynecologic malignancies.

Clinical features of American versus non-American gynecologic cancer patients requesting information from a proprietary web-based decision-support program.

PURPOSE: As the Internet can potentially substantially reduce geographic barriers to the dissemination of health-related information, it would be interesting to know if non-American women with gynecologic malignancies accessing United States (US)-based cancer Web sites differ from American patients with the same illness. PATIENTS AND METHODS: Aggregate data from individuals providing personal clinical information into one of four proprietary gynecologic cancer (cervix, endometrial, newly diagnosed and recurrent ovarian cancers) decision-support programs (NexProfiler Treatment Option Tools for Cancer; NexCura Inc., Seattle WA, USA) currently embedded within approximately 100 established cancer-related Web sites were examined for differences between American versus non-American patient populations. RESULTS: In this analysis, which included >15,000 patients, American and non-American gynecologic cancer patients were remarkably similar in most clinical characteristics, including age, stage of disease at presentation, overall health, and desire to receive information regarding clinical trials. Notable differences included features suggestive of a more aggressive surgical philosophy in the US (e.g., higher percentage of American recurrent ovarian cancer patients reported they had undergone a secondary surgical procedure; greater use of radiotherapy in non-American cervical cancer patients). CONCLUSION: Despite differences in geographic location and health care delivery systems, American and non-American patients with gynecologic malignancies and with access to Internet-based cancer information exhibit few, but notable, differences in self-reported clinical characteristics.