Several presentations at the 59th Annual Clinical Meeting of the American College of Obstetricians and Gynecologists (ACOG), held April 30–May 4 in Washington, DC, focused on cancers associated with the reproductive tract and issues important to women’s health. Four noteworthy studies presented at the meeting are summarized below.
Achieving or maintaining fertility in younger patients with cancer is a major challenge that has spawned a new term (ie, oncofertility) and an NIH-funded multidisciplinary organization (The Oncofertility Consortium) to provide information to patients, health professionals, educators, and researchers. Teresa K. Woodruff, PhD, a pioneer in the field of oncofertility, reviewed current options for preserving female fertility, including cryopreservation of embryos, eggs, and ovarian tissue to be used after cancer treatment is completed. She also described a cutting edge technique aimed at producing live human offspring grown in vitro, not in vivo.
“The frozen embryo is the most mature option we have, but patients don’t always have time to take advantage of this technology,,” Dr. Woodruff said. “For those patients, removing an ovary is an option to protect fertility.”
Dr. Woodruff and colleagues at Northwestern University, Feinberg School of Medicine, are working with a three-dimensional supportive environment for the ovarian follicle using alginate, a gelatinous material that does not interact with mammalian cells. The in vitro process has spawned live offspring from mice and produced eggs and embryos in nonhuman primates. Using 40 secondary follicles from 19 patients with cancer, they have gotten good quality eggs and are now trying to recapitulate human folliculogenesis in vitro, which would eliminate the need for tissue transplantation. Once that is achieved, the next step will be to activate the egg.
Detecting Cervical Cancer
An investigational scanning device detected cervical dysplasia up to 2 years earlier than traditional methods—including Pap smear, human papillomavirus test, colposcopy, and biopsy—in a longitudinal pivotal trial reported by Leo B. Twiggs, MD, University of Miami Miller School of Medicine.
The LuViva™ device relies on spectroscopic technology measuring the spectral output (changes in light relative to depth) of cervical tissue. The technique is painless and noninvasive, does not require tissue sampling or laboratory analysis, and produces results within minutes, he said. The cost of the portable device has not yet been determined.
The study enrolled 1,607 women referred for LuViva at seven clinical centers on the basis of an abnormal Pap smear or other finding that suggested endometrial dysplasia. All patients underwent LuViva scanning, as well as an additional Pap test, colposcopy, and biopsy. Each subject acted as her own control.
Among 801 women who had colposcopy within the previous 2 years, LuViva detected cervical intraepithelial neoplasia grade 2 or higher (CIN2+) in 91% of women vs 76% for standard care (all the other methods mentioned above). Dr. Twiggs stated that relying on LuViva instead of standard methods would have reduced the number of false-positive tests by 39% for women with normal histology and by 30% for women with low-grade dysplasia (CIN1).
Age Bias in Ovarian Cancer
Older women (over age 65) appear to be treated less aggressively than the standard of care for ovarian cancer, according to a retrospective study of women in the state of New Hampshire. The study included 281 women identified in the state’s tumor registry who were age 65 to 99 years (mean age, 77 years). Aggressiveness of care was determined using an Aggressiveness Index based on the current standard of care (1 = least aggressive, 5 = most aggressive).
Slightly less than two-thirds of patients (63.4%) had surgery, and 148 had chemotherapy (52.8%). Of those treated with chemotherapy, 71.2% had adjuvant chemotherapy, 10.3% had adjuvant and neoadjuvant therapy, 90.4% had multiagent chemotherapy, and 9.6% had single-agent chemotherapy. Those treated with chemotherapy were on average 4 years younger than those who were not; the average age of those receiving multiagent chemotherapy was 6 years younger than those who received single-agent chemotherapy. A trend was observed toward less aggressive treatment in women with more medical comorbidities (assessed by the Charlson Comorbidity Index).
“Despite this being a healthy population overall, there appears to be a bias toward less aggressive care with older age,” said lead author Elizabeth Lokich, MD, Dartmouth-Hitchcock Medical Center. She suggested that many patients included in the registry were from more rural areas and may have been treated by physicians who were “less aware of how well older patients can do with surgery and chemotherapy [than oncologists at Dartmouth].”
She and her coauthors plan to conduct another study to examine the factors that underlie suboptimal treatment of ovarian cancer in older patients.
Markers for Lymph Node Metastases
A retrospective study of 343 women who had undergone total abdominal hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic and para-aortic lymph node dissection for endometrioid adenocarcinoma of the endometrium suggests that tumors that stain estrogen receptor (ER)-positive, progesterone receptor (PR)-positive, and p53-negative are not likely to be associated with lymph node metastases. None of the 108 patients with grade 1 tumors that stained ER-positive, PR-positive, and p53-negative had positive lymph nodes; among 143 patients with grade 2 disease and 70 with grade 3 disease, positive nodes were detected in only 6 (4.4%) patients with ER-positive, PR-positive, p53-negative tumors.
The study was reported at a poster session by lead author Karina Zapiecki, MD, Division of Gynecologic Oncology, University of Toledo College of Medicine, Ohio. Future studies will look at the correlation between staining in diagnostic biopsy specimens and nodal status. ■
Financial Disclosure: Dr. Lokich reported no potential conflicts of interest. Dr. Woodruff reported no potential conflicts of interest. Dr. Twiggs reported that he is on the speakers bureau for Merck and was previously on the speakers bureau for GlaxoSmithKline.