Search

Background Little is known about resident attitudes toward elective egg freezing (EF) or how educational exposure to EF affects residents’ views and ability to counsel patients. This study aimed to evaluate US OB/GYN residents’ views on elective EF, decisions regarding family planning, and whether education on EF affects these views and self-reported comfort discussing EF with patients. Methods A 32 question survey was emailed to program directors at all US residency programs for distribution to residents. Chi-square tests were used to evaluate the relationship between educational factors and views on EF and comfort counselling patients. Results Of those surveyed, 106 residents and 7 fellows completed the survey (103 female). Almost three quarters of female respondents reported postponing pregnancy due to residency (71.8%). Non-exclusive reasons for this choice included career plans (54.4%) and concern for childcare (51.5%) and for fellow residents and their program (50.5%). Of the male and female residents who reported educational exposure to EF (57.5%), almost all of them (95.4%) received this in an REI rotation. Only half of female residents reported being comfortable counseling a patient on EF (49.5%). For female residents, education on EF (p = 0.03) and more advanced level of residency (p = 0.02) were significantly associated with comfort counseling a patient on EF. Conclusions Female OB/GYN residents are choosing to delay pregnancy during residency for career and social support reasons. Few residents feel comfortable counseling patients on EF, but appropriate curricular content on EF during residency could improve residents’ comfort in assisting patients with reproductive planning. Electronic supplementary material The online version of this article (10.1186/s12958-019-0459-x) contains supplementary material, which is available to authorized users.

Pre-adolescent girls (9-15years) have the option of receiving a two dose HPV vaccine series at either a six month or one year interval to provide protection from HPV 16, the most prevalent type associated with cervical cancers, as well as several other less prevalent types. This series of vaccinations is highly likely to protect her from HPV infection until she enters the routine screening program, whether that be primary HPV testing or a combination of HPV testing and cytology. The two dose program has been recommended by the World Health Organization (WHO) since 2015. For women 15years and older, the three dose vaccine schedule is still recommended. The past ten years of Gardasil use has provided evidence of reduced HPV 16/18 infections in countries where there has been high coverage. Gardasil9 has replaced Gardasil. Gardasil9 has the same rapid anti-HPV 18 and HPV45 titer loss as Gardasil did. Cervarix remains equivalent to Gardasil9 in the prevention of HPV infections and precancers of any HPV type; Cervarix also has demonstrated sustained high antibody titers for at least 10years. One dose of Cervarix provides protection against HPV 16/18 infection with robust antibody titers well above natural infection titers. This may offer the easiest and most cost effective vaccination program over time, especially in low and lower middle income countries. Cervical cancer screening must continue to control cancer incidence over the upcoming decades. Future studies of prophylactic HPV vaccines, as defined by the WHO, must demonstrate protection against six month type specific persistent infections, not actual cervical cancer precursor disease endpoints, such as cervical intraepithelial neoplasia grade 3 (CIN 3) or adenocarcinoma in situ (AIS). This simplifies and makes less expensive future comparative studies between existing and new generic vaccines.

Substantial evidence showed that T cells are the key effectors in immune-mediated tumor eradication; however, most T cells do not exhibit antitumor specificity. In this study, a bispecific T cell engager (BiTE) approach was used to direct T cells to recognize B7H6+ tumor cells. B7H6 is a specific ligand for the NK cell–activating receptor NKp30. B7H6 is expressed on various types of primary human tumors, including leukemia, lymphoma, and gastrointestinal stromal tumors, but it is not constitutively expressed on normal tissues. Data from this study showed that B7H6-specific BiTEs direct T cells to mediate cellular cytotoxicity and IFN-γ secretion upon coculturing with B7H6+ tumors. Furthermore, B7H6-specific BiTE exhibited no self-reactivity to proinflammatory monocytes. In vivo, B7H6-specific BiTE greatly enhanced the survival benefit of RMA/B7H6 lymphoma-bearing mice through perforin and IFN-γ effector mechanisms. In addition, long-term survivor mice were protected against an RMA lymphoma tumor rechallenge. The B7H6-specific BiTE therapy also decreased tumor burden in murine melanoma and ovarian cancer models. In conclusion, B7H6-specific BiTE activates host T cells and has the potential to treat various B7H6+ hematological and solid tumors.

Chimeric antigen receptor (CAR) T cell therapies have demonstrated durable and potentially curative therapeutic efficacy against B cell leukemia in clinical trials. A CAR strategy can target any tumor surface antigens as long as an antigen-binding receptor can be generated. New CARs which target solid tumors and have the potential to target multiple tumor types are needed. In this study, B7H6, a ligand for the NK cell activating receptor NKp30, was targeted to create a CAR which targets multiple tumor types. B7H6 is expressed on various primary human tumors, including leukemia, lymphoma, and gastrointestinal stromal tumors (GISTs), but it is not constitutively expressed on normal tissues. B7H6-specific CAR T cells have robust cellular cytotoxicity and IFN-γ secretion when co-cultured with B7H6+ tumor cells, and they exhibit little self-reactivity to immature dendritic cells (iDCs) or pro-inflammatory monocytes. In vivo, B7H6-specific CAR T cells greatly enhanced the survival of RMA/B7H6 lymphoma bearing mice. The long-term survivor mice were protected against a B7H6-deficient tumor re-challenge. This CAR therapy also decreased tumor burden in a murine ovarian cancer model. In conclusion, B7H6-specific CARs have the potential to treat B7H6+ hematologic and solid tumors.

Objective The aim of this study was to investigate the efficacy and safety of intraperitoneal catumaxomab in heavily pretreated patients with chemotherapy-refractory ovarian cancer and recurrent symptomatic malignant ascites. Methods The study is a single-arm open-label multicenter US phase II study. Patients received 4 three-hour intraperitoneal catumaxomab infusions (10, 20, 50, and 150 μg within 10 days). The primary end point was the percentage of patients with at least a 4-fold increase in the puncture-free interval (PuFI) relative to the pretreatment interval. The main secondary end points were puncture-free survival, overall survival, ascites symptoms, and safety. Time to first therapeutic puncture (TTPu) was analyzed post hoc. Results Forty patients were screened, and 32 patients (80%) were treated. Seven patients (23%) achieved the primary end point. The median PuFI was prolonged 2-fold from 12 to 27.5 days. The median TTPu was prolonged 4-fold from 12 to 52 days. The median puncture-free survival and overall survival were 29.5 and 111 days, respectively. Nineteen patients (59%) required puncture after catumaxomab treatment. Ascites symptoms improved in most of the 13 predefined categories. At study end, most symptoms were still improved compared with screening. The most frequent treatment-related adverse events were related to cytokine release (vomiting, nausea, pyrexia, fatigue, and chills) or intraperitoneal administration (abdominal pain). Transient increases in liver parameters and transient decreases in blood lymphocytes were regularly observed but were generally without clinical relevance. Conclusions Catumaxomab prolonged PuFI and TTPu had a beneficial effect on quality of life, as shown by the improvement in ascites symptoms, and had an acceptable safety profile, which is consistent with its mode of action.

Background . Gliomatosis peritonei is a rare condition associated with ovarian teratomas in which benign glial implants are identified on the peritoneal surfaces of the abdomen. The implants have been identified at initial surgery and at second-look laparotomy. Case . Here, we present a case of an 82-year-old female who was diagnosed with gliomatosis peritonei 54 years after her initial surgery for an ovarian dermoid tumor. A separate teratomatous implant containing focally invasive adenocarcinoma was also present. Conclusion . This is by far the longest interval between initial diagnosis and identification of glial implants reported. Additionally, the presence of a separate malignant teratomatous implant suggests that teratomatous implants may retain malignant potential, in contrast to implants composed of purely benign glial tissue.