- Virtual cross-border tumour boards give patients access to specialist expertise and novel treatment options that may not be available locally.
- One in four of the patients reviewed by the European network for complex gynaecological cancers EURACAN G2 gained access to off-label therapies and clinical trials abroad.
LUGANO, Switzerland – Cross-border tumour boards of cancer specialists from different European countries meeting virtually to review the management of individual patients with complex rare gynaecological cancers from across Europe resulted in new treatment recommendations and increased access to clinical trials, according to results from a six-year study that will be presented at the ESMO Gynaecological Cancers Congress 2024. (1)
Gynaecological cancers occur in the female reproductive system and include cervical, ovarian, uterine, vaginal, vulval cancers and gestational trophoblastic tumours. More than half of all gynaecological cancers are classified as ‘rare cancers’, defined as cancers that are diagnosed in fewer than 6 people in every 100 000 of the population each year. (2) The low numbers mean that many cancer centres, even those at regional and national level, have limited experience in diagnosing and managing patients and little or no access to clinical trials. This can lead to delayed diagnosis and limited availability of treatment options for patients. Five-year survival rates are lower for patients with rare cancers (47%) compared to those with common cancers (67%). (3)
“Treating rare gynaecological cancers poses several challenges in terms of lack of consensus on management or shared guidelines and poor availability of clinical trials,” said presenting author Alice Bergamini, Gynaecology and Obstetrics Unit, I.R.C.C.S. Ospedale San Raffaele, Milan, Italy. “There are challenges and major differences also in terms of achieving accurate and timely diagnosis, accessing novel treatment options and providing harmonised care for patients across different countries.”
The European reference network for rare adult cancers (EURACAN) is a virtual network connecting adult patients with rare cancers to expert healthcare centres across Europe; the G2 domain focuses on rare gynaecological cancers. (4) As part of its work, EURACAN G2 organises multidisciplinary tumour boards to enable cancer doctors across Europe to meet virtually to review individual patients with the aim of increasing their access to specialist expertise, novel treatments, and clinical trials.
The new study analysed the impact of EURACAN G2 tumour boards on patient care over the six years from November 2017 to October 2023. During this time 67 multidisciplinary tumour boards with participants from 18 European countries reviewed a total of 260 patients with complex gynaecological cancers. “The number of cases discussed has increased substantially over this time as well as the number of doctors participating,” reported Bergamini.
Results showed that the number of patients reviewed by the group nearly doubled over the six-year period. Further diagnostic testing was recommended in over one in three of the patients and new treatment opportunities to those originally planned were suggested for more than half of the women. Adherence to these treatment recommendations was high (94%). Bergamini pointed out that surveillance instead of adjuvant chemotherapy was recommended in 17% of patients. “This spared these women the potential side-effects of chemotherapy,” she noted.
Based on recommendations from the virtual tumour board, one in four of the patients gained access to off-label therapies (37 patients) or were enrolled in clinical trials abroad (4 patients). “Patients were able to access off-label therapies not yet approved for rare gynaecological cancers, which would otherwise not have been accessible in some countries,” explained Bergamini.
“This approach is a key strategy to improve the treatment of patients with rare and complex cancers by bringing together leading experts from relevant fields in different countries. It gives patients access to expertise not possible in individual centres, helps to overcome resource limitations and provides patients with access to off-label treatments and clinical trials in other countries.” Bergamini considered that cross-border tumour boards also help to improve harmonisation of treatment across different countries. “In addition, networking and clinical collaboration was of huge educational value to clinicians; we learned a lot from working together at these multidisciplinary tumour boards.”
The new findings showing the value of cross-border tumour boards are encouraging for using this approach in patients with other types of rare cancers. EURACAN currently has 10 groups working in rare adult solid tumour cancers, from head and neck cancers to those affecting the digestive tract.
“The virtual tumour board approach we are using for complex gynaecological cancers is completely feasible in other rare cancer domains, such as sarcoma,” said prof. Isabelle Ray-Coquard, president of the Groupe d’investigateurs national evaluation des cancers de l’ovaire (GINECO), Centre Leon Bérard, Université Claude Bernard, Lyon, France and Chair of EURACAN G2 domain. She added that cross-border tumour boards for patients with sarcoma are now underway but also cautioned that the use of this approach in different types of rare cancers depends on whether it helps to meet the unmet needs.
At the same time as developing new ways to improve access to specialist care and treatment options for patients with rare cancers, prof. Ray-Coquard considered that research in rare cancers is essential to optimising diagnosis and treatment. “Rare cancers account for 24% of all of our cancer patients. But there have been no new treatment options for many rare cancers for the last 20 years,” she warned. “We need to continue research to develop new hypotheses that can form the basis for developing novel therapies with a high likelihood of success in clinical trials.”
Notes to Editors
Please make sure to use the official name of the meeting in your reports: ESMO Gynaecological Cancers Congress 2024 and the official congress Hashtag: #ESMOGynae24. Follow it to stay up to date and use it to take part in the conversation on X (Twitter), LinkedIn, Instagram, Facebook
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References
- Bergamini A, Joneborg U, Marquina G et al. European multi-disciplinary tumor boards within the EURACAN network increasingly support management of patients with rare gynecological tumors: 6 year activity results. Abstract 82MO that will be presented at the ESMO Gynaecological Cancers Congress 2024 (20-22 June), Mini Oral Session on Friday, 21 June, 10:20 to 11:50 (CEST) in the Auditorium.
- Blay J-Y, Casali P, Bouvier C et al. European Reference Network for rare adult solid cancers, statement and integration to health care systems of member states: a position paper of the ERN EURACAN ESMO Open 2021; 6, 100174
- Joneborg U, Bergamini A, Wallin E et al. European multidisciplinary tumor boards support cross-border networking and increase treatment options for patients with rare gynecological tumors. International Journal of Gynecological Cancer 2023; 33: 1621-1626
- EURACAN. https://euracan.eu. Accessed 4 June 2024.
A. Bergamini1, U. Joneborg2, G. Marquina3, E. Grassi4, E. Wallin2, A. Casado Herraez5, O. Solheim6, C.M. Sassu7, C. Lok8, M. Bini9, P. Pautier10, F. Kridelka11, J. Sehouli12, E. Van Nieuwenhuysen13, J. Coulter14, P-A. Bolze15, C. Lebreton16, P. Jurgen17, I.L. Ray-Coquard18, M.J. Seckl19 [Text Wrapping Break]1Gynaecological Oncology, IRCCS Ospedale San Raffaele, Milan, Italy, 22. Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden, 3Medical Oncology, Hospital Clinico Universitario San Carlos, Madrid, Spain, 41. Department of Gynaecological Oncology, IRCCS Ospedale San Raffaele, Milan, Italy, 5Medical Oncology Department, Hospital Clinico Universitario San Carlos, Madrid, Spain, 6Sep.of Gynacological Oncology, Oslo University Hospital - The Norwegian Radium Hospital, Oslo, Norway, 7Dipartimento Scienze della Salute della Donna, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy, 8Gynecologic Oncology, NKI-AVL - Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands, 9Dipartimento di Oncologia, Istituto Nazionale dei Tumori di Milano - Fondazione IRCCS, Milan, Italy, 10Medicine Department, Institut Gustave Roussy, Villejuif, France, 11Chu de Liege, CHU de Liège - Sart Tilman Site, Liège, Belgium, 12Gynecology, Charité - Universitaetsmedizin Berlin, Berlin, Germany, 13Gynaecological Oncology Department, UZ Leuven - University Hospitals Leuven - Campus Gasthuisberg, Leuven, Belgium, 1412. Department of Gynaecological Oncology, CUH - Cork University Hospital, Cork, Ireland, 15Centre Français de Référence des Maladies Trophoblastiques, CICLY - Centre pour l'lnnovation en Cancérologie de Lyon - Université Lyon 1-EA 3738, Oullins, France, 16Medical Oncology Department, Institute Bergonié - Centre Régional de Lutte Contre le Cancer (CLCC), Bordeaux, France, 1715. Department of Obstetrics and Gynecology, Catharina Hospital Eindhoven, Eindhoven, Netherlands, 18Medical Oncology Department, Centre Léon Bérard, Lyon, France, 19Surgery and Cancer Department, Charing Cross Hospital - Imperial College Healthcare NHS Trust, London, UK
Background: The European Reference Network for Rare Adult Cancers (EURACAN) G2 domain deals with rare gynaecological cancers. Within this domain, virtual multi-disciplinary tumor boards (MDTs) were implemented to advise on clinical management of complex cases. Here, we present the 6-year activity outcomes.
Methods: EURACAN G2 MDTs were organized monthly since November 2017 by Karolinska University Hospital, Stockholm. From March 2021 to March 2023, the MDTs were coordinated by Ospedale San Raffaele, Milan and since April 2023 by Hospital Clinico San Carlos, Madrid. A summary of cases was circulated to participants prior to MDTs and recommendations were distributed following each MDT. Background data and outcomes were registered prospectively. Follow up data were collected until March 2024
Results: Between November 2017 and October 2023, 67 MDTs were held with participants from 18 countries and 20 centers. 260 patients were discussed (median 4 patients/session, range 1-12). Background data are shown in the table. The number of annual cases discussed has increased over time (+182% from 2017 to 2022), as is the median number of participants (+27% from 2020 to 2022). The MDTs resulted in a recommendation for pathological review and genetic sequencing in 24% and 9.6% of cases. Surveillance was recommended for 17% of cases. Alternative treatment opportunities were suggested for 58.7% of patients compared to the initial proposed management. Follow up data were available for 155 patients. Adherence to treatment recommendation was 94%. As a consequence of MDT recommendations, access to off-label therapies was achieved in 37 patients (23.8%) and 4 patients (2.5%) were enrolled in clinical trials abroad. [Text Wrapping Break]
Table: 82MO
Patients N=260 |
|
DIAGNOSIS |
|
Gestational trophoblastic disease |
51(19.6%) |
Malignant ovarian germ cell tumors |
51 (19.6%) |
Sex cord stromal tumors |
38 (14.6%) |
Other Rare ovarian histologies |
76 (29.2%) |
Rare uterine tumors |
20 (7.8%) |
Rare cervical tumors |
11 (4.2%) |
Other |
13 (5%) |
PREVIOUS LINES OF TREATMENT(median, range) |
1 (0-10) |
INDICATIONS FOR DISCUSSION* |
|
Initial management |
117(42.5%) |
Relapse/disease Progression |
133(48.4%) |
Other (follow up, further investigation) |
25(9.1%) |
* N= 275 case discussions | |
Conclusions: EURACAN G2 domain MDTs increasingly offer opportunity for clinical support and access to treatment alternatives for patients with complex rare gynecological cancers.
Legal entity responsible for the study: EURACAN G2 network.
Funding: Has not received any funding.
Disclosure: All authors have declared no conflicts of interest.