I had a great opportunity last week to showcase the Every Woman Study, low- and middle-income (LMIC) edition at the European Society for Gynaecologic Oncology Meeting in Rome, with a poster outlining potentially novel indicators for optimal cytoreductive surgery beyond age and stage of disease on diagnosis. Using data from 2446 women in the 22 LMICs, our initial analysis shows levels of awareness, family income, human development index status of the country and distance to treatment centre as potentially also playing a part.
Click here to read the poster.
Conferences such as these are very much about the latest treatments or procedures and constantly push the boundaries of what clinicians can achieve. It was great to hear after several years, the language coming together around the use of PARP inhibitors – “not using them on women with BRCA mutations or those who have homologous recombination deficiency (HRD) is akin to causing harm”, and the first breakthrough in several years for women who are platinum resistant, with Mirvetuximab, an antibody conjugate drug or ADC. Are you lost already in the acronyms? It is all very positive, but for the World Ovarian Cancer Coalition, and clinicians working in low- and middle-income countries, these treatments, and the genomic profile/genetic testing that are needed to correctly use these drugs are still a pipe dream in many situations. It’s not just about access, but affordability, with the very expensive price tags falling on the women and their families. Not one patient in our African cohort in the study received a PARP inhibitor.
So it felt like an important moment to get issues like this raised. I was also really interested to come across work by the GINECO group looking at KELIM scores in Japanese women. KELIM is an emerging method of using CA125 scores to predict responsiveness to chemotherapy, and in the future could also help determine HRD status in the form of a very cheap test. They showed that for Japanese women, the cut off figures for CA125 would need to be different, basically that women from different ethnic backgrounds respond differently, yet for the time being, all women are prescribed drugs and procedures based on trials carried out on mainly white women in the global north. There was also an interesting presentation on toxicity with PARP inhibitors, and how that varied, depending on where the mutations in the BRCA gene occurred. The future really could be much more personalised medicine, as long as the ovarian cancer community and governments work hard to involve and include women from diverse backgrounds.
It’s always hard to know how many people saw the EWS poster, but I had some positive chats with researchers, the poster was also available online and will be published in the International Journal of Gynecologic Cancer. I was delighted as well to meet Dr Edson Mamani, from Arequipa in Peru. He bounded up to me like an old friend, to let me know he had been one of the doctors recruiting women into the study, and was thrilled to have taken part in such an important piece of work.
Thank you ESGO for the opportunity.