Since the first genome sequencing in 2001, advances in genomics applied to the treatment of numerous diseases, including cancer, have not stopped growing. "Now, we are investigating new molecules many of them focussed on blocking mutations or genetic alterations of cancer. “We are entering a genomic era and we have to treat tumors according to this era”, says Dr. Raul Marquez, head of the Gynecologic Tumor Unit of the Medical Oncology Service at MD Anderson Cancer Center Madrid and one of the directors of the VI Congress on Gynecologic Oncology, a professional meeting that gathers the best specialists in gynecologic tumors from around the world every two years. In this edition, it is expected that there will be approximately 300 specialists in this type of tumor.
Organized by Dr. Marquez and Dr. Javier de Santiago, head of the Gynecologic Oncology Service at MD Anderson Madrid and by Dr. Robert Coleman and Dr. Shannon N. Westin, Department of Gynecologic Oncology and Reproductive Medicine at MD Anderson Cancer Center in Houston, Dr. Marquez explains the appointment aims to be "a consensus conference between Europe and America, countries that differ in their practical way of working on the same science that unites us all".
An encounter that will be fundamentally focused on the issue of genomics because, as pointed out by Dr. Gema Moreno, chief counsel of the Translational Research Laboratory at MD Anderson Madrid, "to date, it is no longer possible to understand a cancer diagnosis without an approach that properly classifies the cancer subtype of each patient". In fact, the specialist continues, "although currently only done in clinical trials, in the next few years we will implement therapies in the first line of treatment according to the specific molecular profile of each patient".
A 'Molecular Tumor Board' to treat each patient as a unique case
As science advances in the knowledge of genomics, it becomes increasingly possible to treat drugs with much more specificity and sensitivity, which will allow us to treat cancer in the future in a much more selective way. "This is our philosophy", states Dr. Moreno, who emphasizes that the center's commitment to the future is the "realization of genetic studies for all patients in order to design a completely personalized treatment for each case". At the moment, MD Anderson Madrid has already created a committee with this objective, the 'Molecular Tumor Board', composed of a multidisciplinary team of professionals.
In this line, one of the conferences organized by Dr. Moreno and Dr. Sonsoles Alonso, of the Genetic Counseling Unit in Hereditary Cancers at MD Anderson Madrid, will discuss the usefulness of genomics in endometrial cancer. Currently, genomic studies are used only for the study of women with a family history of endometrial cancer and for monitoring the tumor of patients with the aim of identifying a relapse or tumor progression in advance.
Now, Dr. Moreno and Dr. Alonso have also launched a study at MD Anderson Madrid with women at high risk of developing endometrial cancer to find out if the study and detection of a mutation in very early stages, from a genetic test, would allow the professionals to precede the development of the disease. Different lines of research in endometrial cancer are also being opened, both in early stages and in advanced or metastatic stages, based on molecular studies.
Pharmacological news in ovarian cancer
Ovarian cancer will be the main protagonist of the sixth edition of the International Congress of Gynecologic Oncology due, above all, to the approval of PARP inhibitors as a standard of treatment in patients with ovarian cancer. "These molecules have been introduced in the first line of treatment and also in recurrent ovarian cancer," says Dr. De Santiago, who highlights the positive results that have been obtained in recent years with immunotherapy, at the moment in third line treatment.
Another interesting approach in this type of cancer is the study of the tumor microenvironment as a therapeutic target, a topic that Dr. Coleman will address during the congress. "The tumor generates a favorable environment for itself, so the idea here is to turn the environment into a hostile environment and then begin treatment," says Dr. de Santiago, who will moderate the intervention of Dr. Coleman. This research is still in the very early stages, and what changes are occurring in the microenvironment are being analyzed to later determine whether these changes could be used as a therapeutic target.
In addition, Dr. de Santiago will present in his lecture the positive experience of the center with primary cytoreduction in patients with ovarian cancer. "We think that the initial treatment should be surgical as far as possible. Our experience tells us that patients who are operated on as a first option obtain better results, although it is important to make sure beforehand we can remove all the disease so as not to subject patients to unnecessary risk”, he emphasizes.
And, finally, Dr. Marquez will resume a technique that was used a few years ago, intraperitoneal chemotherapy, and which now seems to be relegated to the background due to the arrival of new treatments such as anti-angiogenesis and PARP inhibitors. "In a center with experience in this technique and in selected patients, young and in good general health, very good results are achieved", he emphasizes.
Also, during the Congress, professionals from different specialties will have the opportunity to discuss scientific controversies in the approach to gynecologic tumors. Thus, for example, although there seems to be consensus that surgery should be the first treatment also for endometrial cancer, the decision about the subsequent sequence of treatment with chemotherapy and radiotherapy is not as unanimous. In cervical cancer, the controversy is different and revolves around whether neadyuvant treatment with chemotherapy, prior to surgery, could be more effective in these patients than performing the intervention directly.
Patients will also be at the center and will be protagonists in this edition, since there will be a conference devoted to deepening the importance of patient participation in clinical trials for the advancement of research, and another conference focused on the need for psychological support before, during and after cancer treatment.