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The International Journal of Gynecological Cancer publishes content on novel and relevant topics in the field of gynecologic cancer. IJGC Podcast features short interview segments with leading experts discussing the latest research in their respective areas. The podcasts will serve as an interactive and education experience for all our listeners.

* The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.

IJGC Podcast

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Professor Bradley J. Monk to discuss the ATHENA-MONO clinical trial. Prof. Monk is an international thought leader and clinical trialist who has developed and advocated for maintenance treatment in newly diagnosed advanced and recurrent ovarian cancer. ATHENA-MONO represents his fifth positive randomized phase 3 trial studying maintenance treatment and adds confidence to this efficacious and tolerable paradigm changing opportunity for all patients regardless of the molecular genotype (allcomers).

Highlights:
- Maintenance therapy is now the global standard of care in patients with advanced or recurrent epithelial ovarian cancer. This can include a PAPP inhibitor, bevacizumab, or the combination.
- Maintenance treatment is efficacious in all molecular subgroups and is tolerable without an impairment in the quality of life.
- Payers acknowledge the value of maintenance treatment as do consensus guidelines.

ATHENA-MONO Trial with Bradley J. Monk

In this episode of the IJGC podcast, Editor-in-Chief, Dr. Pedro Ramirez, is joined by Dr. Giuseppe Caruso discuss post-PARP myeloid neoplasms. Dr. Caruso is a fifth-year resident in Obstetrics and Gynecology and a first-year fellow of the PhD in “Network Oncology and Precision Medicine” at Sapienza University of Rome in Italy. Over the past year, he has been attending the Department of Gynecologic Oncology at the European Institution of Oncology (Milan) under the mentorship of Professor Nicoletta Colombo and has now started his research fellowship period at Mayo Clinic (Rochester) under the supervision of Professor William Cliby. His main interest areas are gynecologic oncology, personalized oncology, and clinical research.

Highlights:

- Myeloid neoplasms post PARPi in patients with ovarian cancer are gradually emerging as life-threatening late toxicities and should not be underestimated.

- The first two years of PARPi exposure are the critical window of onset and persistent cytopenia has been recognized as an early warning sign.

- Active surveillance, differential diagnosis, and prompt hematological referral are crucial.

- PARPi are recommended in the first line also to improve the risk-benefit ratio.

- PARPi should be used cautiously in patients with a higher baseline risk and/or those who are less likely to have a significant benefit.

Post-PARP Myeloid Neoplasms with Giuseppe Caruso

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Rene Pareja to discuss recent the cervical cancer management updates. Dr. Pareja is a gynecologist-oncologist at Astorga Oncology Clinic in Medellín and the National Cancer Institute in Bogotá, Colombia. He is a reviewer for more than 20 specialty journals and is an Associate Editor for IJGC. He is the author of ten book chapters and more than 80 publications in peer-reviewed journals, and at IGCS 2021 he received an award for Community Advancement in Resource-Limited Settings.

Highlights:
 - There is controversy in offering minimally invasive approaches to women with early-stage cervical cancer and tumors less than 2 cm.
 - The role of surgical staging remains controversial because guidelines still recommend it, despite evidence of a negative prospective randomized controlled trial.
 - Intermediate risk factors after a radical hysterectomy need to be re-evaluated in a very well designed prospective randomized trial, with modern radiotherapy techniques and updated inclusion criteria.

Cervical Cancer Management Updates with Rene Pareja

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Carien Creutzberg, Nanda Horeweg, and Alexandra Leary to discuss the RAINBO trials. Carien Creutzberg is Professor of Radiation Oncology at Leiden University Medical Center, the Netherlands. She specializes in research and treatment of gynecological cancers and has been the initiator and principal investigator of the four PORTEC trials and the TransPORTEC consortium. She is current chair of the GCIG Endometrial Cancer Committee and past Council member of ESGO and IGCS. Nanda Horeweg is senior researcher at the department of Radiation Oncology of Leiden University Medical Center, the Netherlands. She is one of the principal investigators of the PORTEC team and the international coordinator of the RAINBO program of clinical trials. Alexandra Leary, MD, PhD, is a medical oncologist specializing in gynecological cancers at Gustave Roussy Cancer Center in France. She is the CI for the RAINBO-RED trial and member of the TransPORTEC Consortium. She is current chair of the GCIG Phase II committee, gyne track chair for ESMO Asia, and past gyne track chair for ESMO.

RAINBO Trials with Carien Creutzberg, Nanda Horeweg, and Alexandra Leary

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Ramez N. Eskander to discuss NRG-018 pembrolizumab and chemotherapy in uterine cancer. Dr. Eskander is a gynecologic oncologist who specializes in the comprehensive management of female reproductive system cancers, including ovarian, uterine, cervical, vulvar and vaginal cancer. His expertise includes diagnostic and therapeutic procedures, including minimally invasive (robotic) surgery, chemotherapy and novel drugs.

Highlights:

• NRG-GY018 showed that the addition of pembrolizumab to chemotherapy, followed by maintenance pembrolizumab, resulted in a 70% lower risk of disease progression or death in patients in the dMMR cohort and a 46% lower risk in the pMMR cohort than in the placebo group.

• These data suggest that the incorporation of immunotherapy into the first-line treatment of advanced or recurrent endometrial cancer improves oncologic outcomes, regardless of MMR status or histologic findings.

• Previous monotherapy drugs against PD-1 and PD-L1 in recurrent or metastatic pMMR endometrial cancer resulted in only modest improvement.

NRG-018 Pembrolizumab and Chemotherapy in Uterine Cancer with Ramez Eskander

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Diego Raimondo and Giulia Rovero. 

Dr. Raimondo works as medical director and assistant researcher at the Division of Gynecology and Pathophysiology of Human Reproduction, Bologna, Italy, directed by Prof. Renato Seracchioli. He received his PhD on new technologies for endometriosis surgical removal from the University of Bologna in 2021. He is an Advisory Board Member of the ESGE (European Society for Gynaecological Endoscopy) and member of the Special Interest Group in Robotics. His research interests are focused on minimally invasive surgery (laparoscopic, robotic and hysteroscopic) for endometriosis and endometrial cancer. 

Dr. Giulia Rovero graduated in Medicine in 2017 at the University of Florence. She is currently a fifth-year resident at the Division of Gynecology and Pathophysiology of Human Reproduction, Bologna, Italy, directed by Prof. Renato Seracchioli. In 2022/23 she spent twelve months at the Lariboisiere Hospital in Paris focusing on gynecologic oncology. She is developing her research activity in collaboration with Dr. Raimondo in the field of minimally invasive surgery for endometrial cancer. 

Highlights:

* In endometrial carcinoma (EC) patients, the rate of sentinel lymph node (SLN) mapping failure ranges from 20% to 25%.
* Pooled data assessing predictive factors of SLN mapping failure in EC patients undergoing SLN biopsy through the cervical injection of indocyanine green (ICG) are lacking.
* ICG dose <3mL, advanced FIGO stage, lymph node involvement and bulky lymph node are predictive factors of SLN mapping failure in EC patients.
* Neither clinical features (i.e., BMI >30 kg/m2, menopausal status, adenomyosis) nor surgical history is significantly associated with SLN mapping failure in EC patients.
* Deep myometrial invasion, FIGO grade 3, non-endometrioid histotype, and lymphovascular space invasion are not significantly associated with SLN mapping failure in EC patients.

ATHENA-MONO Trial with Bradley J. Monk

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