Investigator
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Screening of human papilloma virus-related anogenital cancers in immunocompromised women: a systematic review of clinical practice guidelines.
Human papillomavirus-related anogenital cancers disproportionately affect immunocompromised patients due to poor clearance rates and accelerated oncogenicity. This systematic review compares anogenital cancer screening Clinical Practice Guidelines among different subpopulations of immunocompromised women. We conducted a systematic review of guidelines addressing cervical, anal, vaginal, and vulvar cancer screening among immunocompromised women published between 2004 and 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Recommendations were categorized for women with human immunodeficiency virus, transplant recipients, and those with autoimmune conditions. The final review included 26 guidelines. Guidelines for transplant recipients and women with autoimmune conditions were of poorer quality. Only 7 high-quality guidelines addressed resource-limited settings. There was no consensus on cervical cancer screening recommendations regarding initiation, cessation, frequency, methods, and colposcopy referral. Newer guidelines increasingly recommended triennial human papillomavirus testing or co-testing. For anal screening, most guidelines recommended annual cytology starting at age 45 if there is access to high-resolution anoscopy. Otherwise, digital anal rectal examination was recommended. One guideline addressed vaginal cancer screening in post-hysterectomy women with human immunodeficiency virus. It recommended annual vaginal cuff Pap testing and vaginal colposcopy for abnormal cytology or concomitant vulvar lesions. Routine vulvar cancer screening was not recommended. More high-quality guidelines are required for immunocompromised women. Recommendations tailored to low- and lower-middle-income countries are urgently needed. Future guidelines should address the expansion of novel biologics, increased survival among various immunocompromised patient groups (eg, those with end-stage renal disease), and the need for differential screening algorithms according to levels of immunosuppression.
Comprehensive characterization of genomic features and clinical outcomes following targeted therapy and secondary cytoreductive surgery in OCCC: a single center experience
Ovarian clear cell carcinoma (OCCC) is associated with chemoresistance. Limited data exists regarding the efficacy of targeted therapies such as immune checkpoint inhibitors (ICI) and bevacizumab, and the role of secondary cytoreductive surgery (SCS). We retrospectively analyzed genomic features and treatment outcomes of 172 OCCC patients treated at our institution from January 2000 to May 2022. Next-generation sequencing (NGS) was performed where sufficient archival tissue was available. 64.0% of patients were diagnosed at an early stage, and 36.0% at an advanced stage. Patients with advanced/relapsed OCCC who received platinum-based chemotherapy plus bevacizumab followed by maintenance bevacizumab had a median first-line progression-free survival (PFS) of 12.2 months, compared with 9.3 months for chemotherapy alone (hazard ratio=0.69; 95% confidence interval [CI]=0.33, 1.45). In 27 patients who received an ICI, the overall response rate was 18.5% and median duration of response was 7.4 months (95% CI=6.5, 8.3). In 17 carefully selected patients with fewer than 3 sites of relapse, median PFS was 35 months (95% CI=0, 73.5) and median overall survival was 96.8 months (95% CI=44.6, 149.0) after SCS. NGS on 58 tumors revealed common mutations in Our study demonstrates encouraging outcomes with bevacizumab and ICI, and SCS in select relapsed OCCC patients. Prospective trials are warranted.
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