A comparison of two psychological interventions for newly-diagnosed gynecological cancer patients.

OBJECTIVE: This study compared the efficacy of two psychological interventions, a coping and communication-enhancing intervention (CCI) and supportive counseling (SC), in reducing depressive symptoms, cancer-specific distress, fear of recurrence, and emotional well-being of women diagnosed with gynecological cancer. Demographic, medical, and psychological moderators of intervention effects were evaluated. METHODS: Three hundred fifty-two women with gynecological cancer were randomly assigned to eight sessions of CCI, eight sessions of SC, or usual care (UC). Participants completed measures of distress and wellbeing at six time points over an 18month period of time. RESULTS: CCI had a beneficial impact on depressive symptoms and cancer specific distress over the first six months as compared with UC and SC and had a beneficial impact on emotional well-being. The greater coping skill development in CCI has made it a more effective intervention than traditional SC across a broader range of key psychological outcomes. Declines among women in the SC condition were not significantly different from UC. CONCLUSIONS: The CCI intervention had significant effect on patients' depression, cancer-specific distress, and emotional well-being during a time when the majority of newly diagnosed patients experience elevated levels of distress. Ameliorating such distress post-diagnosis merits its incorporation into clinical care. A brief 8-session structured intervention can be readily applied to this distressed population in need. Brief supportive counseling did not evidence treatment effects, suggesting that more structured approaches are crucial to truly deliver benefits.

Immune activation and response to pembrolizumab in POLE-mutant endometrial cancer.

Antibodies that target the immune checkpoint receptor programmed cell death protein 1 (PD-1) have resulted in prolonged and beneficial responses toward a variety of human cancers. However, anti-PD-1 therapy in some patients provides no benefit and/or results in adverse side effects. The factors that determine whether patients will be drug sensitive or resistant are not fully understood; therefore, genomic assessment of exceptional responders can provide important insight into patient response. Here, we identified a patient with endometrial cancer who had an exceptional response to the anti-PD-1 antibody pembrolizumab. Clinical grade targeted genomic profiling of a pretreatment tumor sample from this individual identified a mutation in DNA polymerase epsilon (POLE) that associated with an ultramutator phenotype. Analysis of The Cancer Genome Atlas (TCGA) revealed that the presence of POLE mutation associates with high mutational burden and elevated expression of several immune checkpoint genes. Together, these data suggest that cancers harboring POLE mutations are good candidates for immune checkpoint inhibitor therapy.