Cross-border tumor boards of cancer specialists from several European countries met effectively to review the management of individual patients with complex rare gynecological cancers from across Europe, resulting in new treatment recommendations and increased access to clinical trials, according to results of a six-year study. to be presented at ESMO Gynecological Cancers Congress 2024.
Gynecological cancers occur in the female reproductive system and include cancers of the cervix, ovaries, uterus, vagina, vulva, and gestational trophoblastic tumors. More than half of gynecological 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. The low numbers mean that many cancer centers, even those at regional and national levels, 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%).
The treatment of rare gynecological cancers poses several challenges in terms of lack of consensus on management or common guidelines and insufficient availability of clinical trials. There are challenges and significant differences, too, in achieving accurate and timely diagnosis, accessing new treatment options and providing harmonized care for patients in different countries.”
Alice Bergamini, Presenting Author, Gynecology and Obstetrics Unit, IRCCS Ospedale San Raffaele, Milan, Italy
The European Reference Network for Rare Cancers in Adults (EURACAN) is a virtual network connecting adult patients with rare cancers to specialist healthcare centers across Europe. the G2 sector focuses on rare gynecological cancers. As part of its work, EURACAN G2 organizes multidisciplinary tumor boards to enable cancer doctors across Europe to meet virtually to examine individual patients with the aim of increasing their access to specialist expertise, new treatments and clinical trials.
The new study analyzed the impact of EURACAN G2 cancer boards on patient care over the six-year period from November 2017 to October 2023. During this period, 67 multidisciplinary tumor boards with participants from 18 European countries reviewed a total of 260 patients with complex gynecological cancers. “The number of cases discussed has increased significantly during this period as well as the number of doctors involved,” Bergamini said.
The results showed that the number of patients seen by the team almost doubled over the six-year period. Further diagnostic tests were recommended for more than one in three of the patients, and new treatment options were suggested to those originally planned 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,” he noted.
Based on virtual tumor board recommendations, one in four patients accessed off-label treatments (37 patients) or enrolled in clinical trials abroad (4 patients). “Patients have been able to access treatments not yet approved for rare gynecological cancers that would otherwise be inaccessible in some countries,” Bergamini explained.
“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 provides patients with access to expertise not possible in individual centers, helps to overcome of resource limitations and provides patients with access to off-label treatments and clinical trials in other countries.” Bergamini felt that cross-border tumor boards also help to harmonize treatment across countries. “Additionally, networking and clin collaboration had tremendous educational value for clinicians; we learned a lot from working together on these multidisciplinary tumor boards.”
The new findings showing the value of cross-border cancer boards are encouraging for the use of this approach in patients with other types of rare cancers. EURACAN currently has 10 groups working on rare adult solid tumors, from head and neck cancers to those affecting the digestive system.
“The virtual tumor array approach we use for complex gynecological cancers is entirely feasible in other rare areas of cancer, such as sarcoma,” said Professor Isabelle Ray-Coquard, president of the national evaluation of ovarian cancers Groupe d’investigateurs (GINECO) , Center Leon Bérard, Université Claude Bernard, Lyon, France and Chair of the EURACAN G2 sector. He added that cross-border tumor panels for sarcoma patients are now underway and also cautioned that the use of this approach in different types of rare cancers depends on whether it helps meet unmet needs.
As well as developing new ways to improve access to specialist care and treatment options for patients with rare cancers, Prof Ray-Coquard felt that research into rare cancers is essential to optimizing diagnosis and treatment. “Rare cancers account for 24% of all our cancer patients. But there have been no new treatment options for many rare cancers in the last 20 years,” he warned. “We need to continue research to develop new hypotheses that can form the basis for the development of new treatments with a high probability of success in clinical trials.”
