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Advances in gynaecological cancer research could change the treatment landscape, say researchers

Novel findings on gynaecological cancers will be revealed later this month at the ESMO Congress 2023 in Madrid

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Advances in gynaecological cancer research could change the treatment landscape, researchers have said, allowing women struggling with these cancers to live longer.

Results from highly anticipated clinical trials in gynaecological cancers with, among others, new data that cover the entire spectrum of managing patients with cervical cancer, will be presented at the ESMO Congress 2023 in Madrid, Spain.

These studies, researchers say, could change the treatment landscape for women with these cancers, delaying the time to relapse and, in some cases, lengthening survival.

“These are exciting results that address unmet needs in gynaecological cancers,” says Professor Krishnansu S. Tewari, director of the Gynecologic Oncology Programme, University of California, Irvine.

Novel findings will be revealed at the congress across the range of gynaecological cancers, including cervical, ovarian, and endometrial cancers.

Cervical cancer usually presents as locally advanced disease in women who have not undergone screening. At this stage, the cancer is too large to remove surgically, and the standard treatment is chemotherapy with radiation.

“Cervical cancer occurs in young women who are typically in the midst of their careers and have small children at home,” explains Tewari.

“Standard treatment does lead to remission, but within two to three years the cancer can come back. Two trials that will be presented at the ESMO Congress 2023 will reveal new ways of treating locally advanced cervical cancer that significantly delay relapse, giving women who are in the prime of their lives more time free of cancer.”

In one study, 68 per cent of women who received the immunotherapy drug pembrolizumab on top of standard treatment were cancer-free at two years, compared to 57 per cent of women allocated to placebo on top of standard treatment.

A second study tested the impact of giving a combination of two different chemotherapy drugs ahead of standard treatment with chemotherapy plus radiation, a strategy called induction chemotherapy.

Women with locally advanced cervical cancer who received induction chemotherapy were 35 per cent more likely to be cancer-free at five years and 39 per cent more likely to be alive at five years compared to those who received standard treatment only.

Tewari says: “Induction chemotherapy could be an accessible treatment option because these drugs are available around the world, including in low-resource countries.”

Also in cervical cancer, trials will be presented showing improvements in survival and delays in relapse with new treatments for women with cancer that has spread to other parts of the body or has come back after being treated.

In ovarian cancer, achieving remission is a high unmet need, say scientists, as approximately 85 per cent of patients experience recurrent disease, with almost no long-term survival after recurrence.

At the ESMO Congress 2023, randomised trial data will be discussed showing that a novel targeted therapy, called senaparib, could delay the time to relapse in patients with newly diagnosed advanced disease.

Studies will also be presented in endometrial cancer, the most common gynaecological cancer in the US and Europe.

While there is no screening test for endometrial cancer, there is an early symptom, post-menopausal bleeding, which means that most endometrial cancers can be cured with a hysterectomy.

“Unfortunately, for the 15-20 per cent of patients that have more aggressive disease, treatment options are very limited and that’s why the studies that will be presented at the ESMO Congress are remarkable,” says Professor Tewari.

“Two trials showed that adding immunotherapy to standard chemotherapy treatment significantly delayed relapse of the cancer in women with advanced/recurrent endometrial cancer compared to chemotherapy alone.”

The researcher thinks the results that will be presented at the ESMO Congress 2023 have a very good chance of leading to regulatory approval of new treatments.

He says: “These trials have set the stage for women with gynaecological cancers to receive state-of-the-art therapies that delay the time to relapse, allowing women struggling with these cancers to live longer and live better.”

Insight

Trust apologises for ‘human error’ after maternity data loss

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Nottingham University Hospitals NHS Trust has apologised after a human error caused 11 years of maternity data to be overwritten.

The incident happened during routine technical work on 18 August, when computer instructions intended to create a copy of a radiotherapy database were mistakenly applied to the maternity database.

Most of the affected information has since been recovered, including notes, observations, test results and other information recorded as part of patient care.

However, the trust has been unable to fully restore the historical record showing who viewed maternity records between September 2011 and November 2022.

Current data was not affected and the incident has had no impact on current maternity services or care provided to women and babies, according to the trust.

It also said no information was accessed or used inappropriately as a result of the incident.

Andy Callow, chief digital and information officer at Nottingham University Hospitals, said: “I am sorry for the concern and distress this incident may cause to women and families affected.

“On 18 August 2026, a human error during a routine technical process resulted in a maternity records database being unintentionally overwritten.

“We took immediate action to investigate the incident and recover the affected information.

“The information needed to support patient care has been restored and there has been no impact on current maternity services or the care provided to women and babies today.

“However, to date, we have been unable to fully restore the historical record showing who viewed maternity records between September 2011 and November 2022.

“We have informed the Information Commissioner’s Office, completed a full investigation and strengthened our processes and controls to help prevent a similar incident from happening again.”

The error occurred when pre-written computer instructions previously used for another hospital system were used during the technical work.

A setting that should have been changed was not altered, resulting in work being carried out on the maternity database instead of the radiotherapy database.

The issue was escalated within minutes of being identified and experts were brought in to recover as much information as possible.

The trust has referred the incident to the Information Commissioner’s Office and notified Nottinghamshire Police, which is conducting a separate criminal investigation into maternity care at the trust.

The force is assessing whether the loss of information about who accessed maternity records could affect that investigation.

The incident follows a maternity review led by midwife Donna Ockenden, which concluded in June after examining the cases of 2,500 families over a 20-year period.

The review found more than 500 mothers and babies suffered potentially avoidable harm, with 162 dying following substandard care. Some babies who survived were left seriously disabled.

Nottinghamshire Police announced its separate criminal investigation, Operation Perth, in September 2023.

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Hormonal health

Mira launches at-home cortisol tracking kit

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Mira has launched an at-home cortisol tracking kit that allows women to monitor stress-related patterns over time using urine samples.

The Cortisol Pattern Kit measures urinary free cortisol directly from a urine sample and displays results through the company’s existing monitor and app.

The system is intended for repeated testing rather than a single measurement, allowing users to compare results with a personal baseline built from their own data.

Mira said consistent daily testing can establish a baseline in about a week. It recommends testing in the morning and evening to see how cortisol patterns change throughout the day.

Cortisol is involved in the body’s stress response but is not a direct or complete measure of stress. The company said the kit is intended for general wellness use and is not designed to diagnose stress, an endocrine condition or any other medical condition.

The Cortisol Pattern Wands use the same lateral-flow testing format as Mira’s existing hormone tests. Users dip a wand into a urine sample, insert it into the Mira Monitor and view the result in the app within minutes.

The company said cortisol data can be viewed alongside cycle, hormone and daily routine information.

Sylvia Kang, founder and chief executive of Mira, said: “The Cortisol Pattern™ Kit gives women a new way to understand their stress patterns over time, in the context of their own biology.”

She added: “We built Mira to give women answers they had spent far too long searching for, beginning with the TTC journey and expanding into hormone and cycle tracking across life stages, including perimenopause. Now, we’re taking Mira beyond reproductive health and into everyday wellness, bringing personalised stress-pattern tracking directly into women’s homes.”

Mira said more than 350,000 women already use its platform to track their cycle and hormones.

Waitlist sign-ups for the Cortisol Pattern Kit and Cortisol Pattern Wands opened on 22 September, with wand refills available to pre-order in 20- and 30-count options.

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Diagnosis

Targeted nanotherapy shows endometriosis promise

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A targeted nanotherapy reduced endometriosis lesions and pain sensitivity after a single dose in mice, early research has found.

The experimental treatment uses a nanoparticle to deliver an existing drug to immune cells associated with endometriosis.

Researchers hope the approach could eventually lead to a treatment for people with the chronic condition, but it has not yet been tested in humans.

Kanako Hayashi, professor in Washington State University’s School of Molecular Biosciences in the College of Veterinary Medicine and a corresponding author of the research, said: “We found the disease-specific immune cell, and then we had a drug, but we couldn’t target the cell with the drug alone.

“So we used this nanocarrier that delivers the drug specifically to the disease site.”

The Washington State University team developed the therapy after previously identifying a distinct population of macrophages associated with endometriosis. Macrophages are white blood cells involved in immune defence.

They designed a nanocarrier, a specialised molecule used to transport drugs to the disease site, to target these cells without affecting surrounding cells and tissue.

The treatment uses niclosamide, a drug approved to treat intestinal tapeworms that is also being studied for other potential uses, including cancer treatment.

Previous research by the team found that niclosamide could reduce endometriosis lesions. However, the drug has low solubility, meaning large amounts are needed for it to work and limiting how long it can safely be taken.

The researchers engineered a nano-sized molecule called a dendrimer to bond with niclosamide and deliver it in a more soluble form.

In a mouse model, a single injection reduced the size and number of endometriosis lesions as well as sensitivity to pain.

Endometriosis affects roughly 190 million women worldwide and occurs when lesions similar to tissue inside the uterus grow outside it.

Symptoms can include chronic pain, severe cramps, pain during sex and infertility. Hormonal therapies can help manage symptoms but may affect fertility and bone density, while surgery can remove lesions but its effectiveness may be short-term.

Recent research has focused on immune system dysfunction in endometriosis, particularly problems involving macrophages.

The researchers are working with the WSU Office of Entrepreneurship and Innovation as they pursue patenting and commercialisation opportunities and seek support to test the technology in human trials.

Hayashi said: “Although we still need to clear multiple phases, this study is telling us the efficacy is strong, and this nanocarrier is stable, so far, for two weeks—and we think we can go longer.

“The idea is that if it’s stable for a month, you could go to the doctor once a month, get the shot, either IV or muscle injection, and then go home.”

 

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