César Gómez-Raposo

Adjuvant chemotherapy in endometrial cancer

The role of adjuvant chemotherapy (CT) is controversial in endometrial carcinoma (EC). Surgery alone is usually curative for women who are at a low risk of disease recurrence. The treatment of EC following surgical staging is based on the risk of relapse, which is defined by the cancer stage at diagnosis, histology of the tumor and other prognostic factors such as grade differentiation, the presence of substantial lymphovascular invasion (LVSI), or depth of myometrial invasion (MI). External beam radiotherapy (EBRT) and/or vaginal brachytherapy (VBT) improved local control and are used as adjuvant treatment for early-stage disease. The role of adjuvant CT is controversial in early-stage EC, and there is no uniform approach to the treatment of women with stage III EC or early-staged non-endometrioid EC. Available evidence did not support the indication of adjuvant CT in stage I-II endometroid EC. In those cases at higher risk of relapse, defined as grade 3 tumors with substantial (no focal) LVSI, specifically with deep MI or cervical involvement, could be considered. Adjuvant CT should be administered to stage III EC patients. When RT is indicated (extensive lymph node involvement or deep MI), sequential treatment with RT or "sandwich" regimen may be considered rather than concurrent CRT. The patients with stage IA MI or IB USC may be offered adjuvant CT alone or in combination with VBT, whereas in stage II uterine serous carcinoma patients adding EBRT may be reasonable. Management approach for patients with stage IA without MI USC who underwent a comprehensive surgery remains controversial, and surveillance alone or CT plus VBT is an appropriate option. Early-stage clear-cell carcinoma patients might not benefit for adjuvant CT, but stage III patients might benefit from the combination of CT and EBRT. Stage I-III uterine carcinosarcoma patients might be offered adjuvant CT followed by RT or as a "sandwich" régimen.

Clinical outcomes and subsequent therapy in patients with platinum-sensitive recurrent ovarian cancer deriving long-term benefit from maintenance niraparib: a subgroup analysis of the GEICO-88R study.

To describe characteristics, clinical outcomes, and subsequent therapies in patients receiving long-term maintenance niraparib in the Spanish expanded-access program. This retrospective observational study (NCT04546373) described patient characteristics, treatment exposure, and clinical outcomes in patients receiving maintenance niraparib for high-grade serous platinum-sensitive recurrent ovarian cancer. Subgroup analyses in patients receiving niraparib for ≥1 year ("long-term responders") were prespecified; additional post hoc analyses explored outcomes in patients treated for ≥2 years ("sustained long-term responders"). In this real-world population of 316 patients (predominantly BRCA wildtype), 107 (34%) were long-term responders and 61 (19%) were sustained long-term responders. Compared with patients discontinuing niraparib within 1 year, the long-term responders subgroup included a higher proportion with primary debulking surgery and no residual disease after cytoreductive surgery and a lower proportion with >4 prior lines of systemic therapy, International Federation of Gynecology and Obstetrics stage IV disease, measurable disease at niraparib initiation, and Eastern Cooperative Oncology Group performance status 1. Tolerability was similar regardless of treatment duration. After discontinuing niraparib, the most frequently administered regimens were platinum-based. Response rates to the first post-niraparib line were 37% to 44%, and median progression-free survival was 7.0 months in non-long-term responders and 7.9 months in long-term responders. Median overall survival was 56.9 months in long-term responders (49.1 months' median follow-up) and was not reached in the sustained long-term responders subgroup. Mature results from the GEICO-88R study continue to support the effectiveness and tolerability of maintenance niraparib in platinum-sensitive recurrent ovarian cancer. A subset of patients experienced long-term disease control. The efficacy of subsequent treatment appeared similar irrespective of niraparib duration.

Addressing unmet needs in long-term survivors of ovarian cancer (ENGOT ov40/NOGGO S13/GEICO 71-R/Expression VI): insights from a Spanish cohort

Ovarian cancer remains a significant global health concern. Contemporary therapeutics have led to an increased number of long-term survivors. This research investigates the unmet needs of long-term ovarian cancer survivors in Spain, focusing on persistent side effects, patient concerns, lifestyle changes, and ongoing challenges. This is a multi-center, cross-sectional, observational study, assessing the results from the international North-Eastern German Society of Gynecological Oncology survey, Expression VI - Long-term survival with ovarian cancer in Spain. Participants were identified during follow-up visits at oncology departments. A structured questionnaire of 68 items, including demographic, clinical, psychosocial, and lifestyle domains, was completed anonymously in printed format, with implied consent through survey completion. A total of 250 long-term ovarian cancer survivors from Spain, defined as patients diagnosed of malignant ovarian cancer with a survival ≥8 years since diagnosis (median age at diagnosis 52 years; median survival time 11 years), completed the survey. A substantial number of participants continued to experience long-term side effects, including gastrointestinal (90%), dermatologic (91.6%), and neurologic symptoms, such as memory problems (15.1%) and concentration difficulties (10.8%). Nearly half of the survivors (47.3%) expressed concerns about nervousness, 43.6% reported ongoing pain, and 40% struggled with sleep disturbances. Lifestyle changes after cancer diagnostic were significant, with 56.5% of smoker participants quitting or reducing smoking and 41.6% adopting healthier diets. Finally, our results indicate that most participants received some form of follow-up, primarily through blood biomarker monitoring (87.0%) and imaging tests (73.0%). This study highlights the persistent challenges among long-term ovarian cancer survivors in Spain, stressing the need for more comprehensive, tailored aftercare. These findings may be generalized to other regions, emphasizing the importance of addressing ongoing side effects and unmet care needs to improve survivors' long-term quality of life. Enhanced follow-up care, patient support, and effective communication are essential components of this effort.