Top advances of the year: Cervical cancer.

The year 2023 was an extraordinary year for the further development and expansion of novel treatments for all patients with cervical cancer, ranging from early stage to later stage and metastatic or recurrent disease. Individuals with early-stage disease will benefit from less invasive surgery with subsequent improvement in quality of life. The effectiveness of immunotherapy has been demonstrated in upfront, locally advanced cervical cancer and confirmed in advanced metastatic disease. Induction chemotherapy will play a role in some patients with locally advanced disease, particularly those in low resource areas of the world. Novel therapeutics including antibody-drug conjugates have shown efficacy even in pretreated patients. As we continue to explore innovative therapeutics in this space, however, we must also continue to improve the diversity of clinical trial accrual to allow for generalizable results. At the same time, we must focus on eradicating this disease with appropriate screening and vaccination.

TP53 mutation and abnormal p53 expression in endometrial cancer: Associations with race and outcomes.

OBJECTIVE: This multi-center cohort study assessed associations between race, TP53 mutations, p53 expression, and histology to investigate racial survival disparities in endometrial cancer (EC). METHODS: Black and White patients with advanced or recurrent EC with Next Generation Sequencing data in the Endometrial Cancer Molecularly Targeted Therapy Consortium database were identified. Clinicopathologic and treatment variables were summarized by race and compared. Overall survival (OS) and progression-free survival (PFS) among all patients were estimated by the Kaplan-Meier method. Cox proportional hazards models estimated the association between race, TP53 status, p53 expression, histology, and survival outcomes. RESULTS: Black patients were more likely than White patients to have TP53-mutated (N = 727, 71.7% vs 49.7%, p < 0.001) and p53-abnormal (N = 362, 71.1% vs 53.2%, p = 0.003) EC. Patients with TP53-mutated EC had worse PFS (HR 2.73 (95% CI 1.88-3.97)) and OS (HR 2.20 (95% CI 1.77-2.74)) compared to those with TP53-wildtype EC. Patients with p53-abnormal EC had worse PFS (HR 2.01 (95% CI 1.22-3.32)) and OS (HR 1.61 (95% CI 1.18-2.19)) compared to those with p53-wildtype EC. After adjusting for TP53 mutation and p53 expression, race was not associated with survival outcomes. The most frequent TP53 variants were at nucleotide positions R273 (n = 54), R248 (n = 38), and R175 (n = 23), rates of which did not differ by race. CONCLUSIONS: Black patients are more likely to have TP53-mutated and p53-abnormal EC, which are associated with worse survival outcomes than TP53- and p53-wildtype EC. The higher frequency of these subtypes among Black patients may contribute to survival disparities.

Top advances of the year: Cervical cancer.

Cervical cancer continues to affect women in the United States and throughout the world despite an effective vaccine against human papillomavirus and cancer screening programs. For the women who develop cervical cancer, surgery, radiation, and chemotherapy have been the mainstays of treatment for years. Recently, novel therapeutics have been developed that offer new treatment opportunities for women living with advanced and/or recurrent disease. Immunotherapy has become an important tool against cervical cancer with the approval of pembrolizumab in the second line for advanced or recurrent disease. Checkpoint inhibitors have recently been approved in the front line for advanced and/or recurrent disease in combination with chemotherapy, and they are being studied in the front line in combination with chemoradiation. Antibody-drug conjugates-specifically tisotumab vedotin (TV)-also have recently received Food and Drug Administration (FDA) approval, and TV is currently being studied in combination with checkpoint inhibitors and with carboplatin. Tumor-infiltrating lymphocytes have been studied in early-phase trials and have shown promise in small patient series. Despite these new therapies, there continue to be racial, ethnic, and socioeconomic inequities with respect to access to care, access to and participation in clinical trials, and survival in the United States as well as globally. New FDA guidance requires researchers to work to reduce disparities by including women of more diverse backgrounds in clinical trials. Finally, as progress continues to be made in the treatment of established disease, prevention through vaccination and screening remains paramount. PLAIN LANGUAGE SUMMARY: The treatment of cervical cancer remains a significant problem in the United States and especially worldwide. Although early cases can be cured, cervical cancer that has spread remains difficult to treat. The past few years have seen significant advances in new therapies and combinations of therapies for women with advanced or recurrent disease. Although this is excellent news for these women, cervical cancer is a preventable disease through screening with Papanicolaou smears and vaccination with the human papillomavirus vaccine. By improving access to and acceptance of screening and vaccination, we can eradicate cervical cancer in the United States and the world.

Enhanced Recovery After Urogynecologic Surgery: A Survey of Patient Experience.

OBJECTIVES: The aim of this study was to identify which aspects/components of the enhanced recovery program (ERP) were associated with a positive patient surgical experience for patients undergoing urogynecologic surgery. METHODS: A total of 198 patients who underwent pelvic reconstructive surgery requiring hospital admission were invited to complete questionnaires modeled after the validated Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey patient experience survey. Patients were asked about 3 phases of ERP interventions: (1) before surgery (patient education, carbohydrate loading), (2) during the hospital stay (pain control, nausea, early ambulation), and (3) after discharge (return of bladder and bowel function). RESULTS: One hundred patients completed the survey (51% response rate). Greater than 90% of patients rated their overall surgical experience favorably (≥8 on 1-10 scale) regardless of age (P = 0.98), race (P = 0.26), education level (P = 0.12), perception of overall health (P = 0.17), or number of prior surgical procedures (P = 0.86). Ninety-two percent of patients reported that preoperative teaching about surgery was "very helpful," and specifically 90% reported that the ERP educational handbook was useful. Patients who reported a poor perception of their overall mental health were more likely to rate their surgical experience less favorably (<8 on 1-10 scale; P = 0.01), as were patients who left the hospital with a Foley catheter (P = 0.03). CONCLUSIONS: Greater than 90% of women surveyed who rated undergoing inpatient pelvic reconstructive surgery positively perceived their surgical experience within the ERP. The majority of patients who had a positive perception of the perioperative experience found the preoperative patient education useful.

Optimal age for genetic cancer predisposition testing in hereditary SMARCA4 Ovarian Cancer Families: How young is too young?

Small cell carcinoma of the ovary, hypercalcemic type is a rare, aggressive, and typically fatal ovarian cancer that primarily affects young women less than 40 years of age. It is caused by a pathogenic variant in the SMARCA4 gene, with nearly half of patients found to have germline pathogenic variants and the remainder demonstrating somatic SMARCA4 pathogenic variants. This case report discusses an illustrative case and explores the existing data and potential recommendations to optimize timing of genetic testing in family members, given the presence of a familial germline pathogenic variant.

The role of pulmonary resection in the management of metastatic gestational trophoblastic neoplasia: Two cases of durable remission following surgery for chemo-resistant disease.

•GTN is typically a chemo-responsive and highly curative gynecologic malignancy.•Surgery may be beneficial in as many as 2/3 of patients with high-risk GTN.•In select patients, resection of drug-resistant pulmonary metastases is effective.