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2018 et 2019 ont été des années prolifiques pour l’oncologie gynécologique pelvienne et, en particulier, les cancers de l’ovaire en termes de résultats de larges études prospectives randomisées. La première, parue dans le NEJM en Janvier 2018 par Van Driel et al. montre pour la première fois un bénéfice de la Chimiothérapie Hyperthermique IntraPéritonéale (CHIP) dans la prise en charge initiale des cancers avancés de l’ovaire ; bénéfice tant en termes de survie sans maladie que de survie globale sans pour autant augmenter de manière significative la morbi-mortalité de la chirurgie. La deuxième, parue également dans le NEJM en décembre 2018, montre le bénéfice incontestable des inhibiteurs de PARP (Olaparib) dans le prise en charge initiale des patientes atteintes d’un cancer avancé de l’ovaire et ayant une mutation BRCA 1 ou 2. La troisième, parue en Févier 2019 par Harter et al., montre de manière assez surprenante que la lymphadenectomie systématique lors de la chirurgie de cytoréduction d’un cancer avancé de l’ovaire (Stade IIB-IV) n’apportait aucun bénéfice en termes de survie sans maladie et de survie globale, même dans le groupe ayant bénéficié de lymphadenectomie, la moitié des patientes avaient une atteinte ganglionnaire. Enfin en septembre 2019, deux autres inhibiteurs de PARP testés dans la prise en charge initiale des cancers de l’ovaire confirment leur intérêt indiscutable.

Extended field chemoradiation is recommended for patients with locally advanced cervical cancer (LACC) and para-aortic lymph node (PALN) metastases. The radiation planning may be based on PET/CT while others recommend to rely on surgical staging. We report the rate of patients for whom the radiation field defined on PET/CT was modified by the histological PALN status. Between March 2010 and December 2016, 168 consecutive patients with LACC underwent a pre-therapeutic PET/CT and PALN dissection. The data were reviewed retrospectively. The diagnostic performance of the PET/CT for definition of PALN status was calculated. We determined the percentage of patients for whom PALN dissection altered the external beam radiotherapy (EBRT) field defined on the PET/CT basis. Of 151 patients with negative PALNs on PET/CT, 26 had histological PALN metastases. Of 17 patients with positive PALNs on PET/CT, 9 were negative on histology of which 7 were located in the common iliac region. Sensitivity, specificity, positive and negative predictive value of PET/CT were 23.5, 93.3, 47.1 and 82.8% respectively. In total, 35 out of 168 patients underwent EBRT - field adaptation (pelvic vs extended field). The rate of radiation field modification (27,7%) was particularly high in the subgroup of patients with metastatic pelvic lymph nodes (PLNs) on PET/CT. Para-aortic surgical staging contributes significantly to individualize the radiation treatment of patients with LACC, particularly for those with positive PLNs at PET/CT. Indication of surgical staging deserves particular attention when the PET/CT suggests positive LNs in the common iliac region.

Poster congrès endométriose Paris mai 2015

Мета дослідження: вивчити частоту настання вагітності після терапії міоми матки уліпристалу ацетатом (УПА).Дизайн: ретроспективний аналіз групи з 52 пацієнток, проспективно включених у дослідження PEARL-II і PEARL-III (The PGL4001 (ulipristal acetate)Effi cacy Assessment in Reduction of Symptoms Due to Uterine Leiomyomata).Заклад: академічна клініка.Пацієнтки: 21-а з 52-х хотіла завагітніти після завершення лікування.Втручання: відсутні.Критерії оцінки: показники настання вагітності і народжуваності.Результати: 21 пацієнтка бажала завагітніти, 15-м (71%) з них це вдалося. Всього зареєстровано 18 вагітностей, з яких 12 завершилися народженням13 здорових дітей, решта 6 завершилися раннім викиднем. Відновлення росту міоми матки під час вагітності не спостерігалося.Висновок: це перше повідомлення про вагітності, що наступили після лікування УПА. Наші дані підтверджують стійкий довгостроковий ефект післятерапії УПА (Fertil Steril®, 2014, Американське товариство репродуктивної медицини [American Society for Reproductive Medicine], 2014)., Design: Retrospective analysis of a series of 52 patients prospectively included in the PGL4001 (ulipristal acetate) Effi cacy Assessment in Reduction of Symptoms Due to Uterine Leiomyomata (PEARL) II and III trials.Setting: Academic hospital.Patient(s): Among the 52 patients, 21 wished to conceive upon treatment completion.Intervention(s): None.Main Outcome Measure(s): Pregnancy rate and live birth rate.Result(s): Twenty-one patients attempted to get pregnant, amongwhom15 (71%) succeeded, totaling 18 pregnancies. Among these 18 pregnancies, 12 resulted in the birth of 13 healthy babies and 6 ended in early miscarriage. No regrowth of fi broids was observed during pregnancy.Conclusion(s): We report the fi rst series of pregnancies achieved after UPA treatment. Our data confi rm a sustained long-term eff ect after UPA therapy. (Fertil Steril®, 2014. by American Society for Reproductive Medicine).

Mathieu Luyckx,1,2 Raffaella Votino,1 Jean-Luc Squifflet,1,2 Jean-François Baurain2,31Gynecology and Andrology Unit, 2Centre du cancer, Gynecologic Oncology Group, 3Medical Oncology Unit, Cliniques Universitaires Saint-Luc, Brussels, BelgiumObjective: Our aim was to review the profile of vintafolide (EC145) and its rationale for use in platinum-resistant ovarian cancer. First we investigated the folate receptors (FRs), folate's pathway into cells, and its expression in normal and cancerous cells, before detailing the mechanism of action of vintafolide, its clinical applications, and the results of different study phases.Materials and methods: A literature search was conducted through Pubmed/Medline, Google, ClinicalTrials.gov and websites of pharmaceutical companies. Only articles in English were selected. All articles investigating folate receptor expression in ovarian cancer were selected first, than articles reviewing platinum resistance. Papers about vintafolide were collected, while those talking about synthesis and biochemistry concerns were excluded. The different Phase I and II studies were read, and an update on the website of pharmaceuticals companies were added.Results: FR is a bundle-membrane receptor that is expressed normally in some normal tissues on the apical surface of cells, but highly expressed in ovarian cancer cells (>80%). It collects folate through endocytosis. Chemotherapy does not modify its expression in ovarian cancer cells, and its expression appears to be mostly associated with a poor prognosis and platinum resistance. Vintafolide is a folate-desacetylvinblastine monohydrazide conjugate, allowing a liberation of the drug into the cytoplasm of cancerous cells via the FR-α (FR α) and endocytosis, with high specificity. Phase I studies showed a 2.5 mg bolus dose to be nontoxic, with moderately adverse events. Phase II clinical trials for the first time demonstrated a statistically significant improvement in disease-free survival in patients with platinum-resistant ovarian cancer, and in those with a very poor prognosis who had already received three to four lines of systemic chemotherapy. The greater benefits were observed in patients with highly expressed FR α.Conclusion: Vintafolide is a promising targeted agent for recurrent platinum-resistant ovarian cancer, first, thanks to its mechanism of action and the characteristics of FRα in ovarian cancer, and, second, because of the favorable results observed in the first clinical trials on platinum-resistant ovarian cancer. Phase III clinical trials are currently ongoing and are expected to confirm these results.Keyword: folate receptor, platinum-resistant ovarian cancer, chemotherapy