bims-ovdlit 2025-04-27 papers

Am Soc Clin Oncol Educ Book. 2025 Jun;45(3): e473834

Multicancer Early Detection Tests at a Crossroads: Commercial Availability Ahead of Definitive Evidence.

Carmen E Guerra, Jennifer Keating Litton, Carolina E Viswanath, A Mark Fendrick.

Multicancer early detection tests (MCEDs), sometimes referred to as liquid biopsies, are tests that can screen for multiple cancers by analyzing blood, urine, and other bodily fluids for biomarkers released by cancer cells. These tests have the potential to change the cancer screening paradigm if they are shown to reduce cancer mortality. However, it is not yet known whether MCEDs reduce mortality. Randomized controlled trials, the gold standard for evaluating cancer screening programs, are currently evaluating the effectiveness of MCEDs. However, because cancer-specific and all-cause mortality are end points that can take years to reach, trials are being designed with surrogate end points such as stage of disease at detection. However, the correlation between cancer stage and survival appears to vary by cancer type, and many have argued that trials must also continue to follow for the gold standard of mortality end points until these surrogate end points are appropriately validated. The widespread use of MCEDs before conclusive evidence supporting their use has the potential to cause harm to patients, could widen health inequities, and further drive health care costs. Consequently, providers should engage in shared decision making regarding MCED tests with patients who inquire about MCEDs emphasizing that MCEDs should be additive to, not replacements for, the currently recommended cancer screening tests.

DOI: https://doi.org/10.1200/EDBK-25-473834

Int J Gynaecol Obstet. 2025 Apr 23.

Letter to the editor: FIGO Position statement on opportunistic salpingectomy as an ovarian cancer prevention strategy.

Annika Strandell, Karin Sundfeldt, Mathias Pålsson, Elin Collins, Anna Darelius, Leonidas Magarakis, Sara Knip, Maria Forslund, Annika Idahl.

DOI: https://doi.org/10.1002/ijgo.70188

N Engl J Med. 2025 Apr 24. 392(16): 1594-1608

Tumor-Infiltrating Clonal Hematopoiesis.

BACKGROUND: Clonal hematopoiesis of indeterminate potential (CHIP) is an age-related condition associated with increased mortality among patients with cancer. CHIP mutations with high variant-allele frequencies can be detected in tumors, a phenomenon we term tumor-infiltrating clonal hematopoiesis (TI-CH). The frequency of TI-CH and its effect on tumor evolution are unclear.
METHODS: We characterized CHIP and TI-CH in 421 patients with early-stage non-small-cell lung cancer (NSCLC) from the TRACERx study and in 49,351 patients from the MSK-IMPACT pan-cancer cohort. We studied the association of TI-CH with survival and disease recurrence and evaluated the functional effect of TET2-mutant CHIP on the biologic features of lung tumors.
RESULTS: Among patients with NSCLC, 42% of those with CHIP had TI-CH. TI-CH independently predicted an increased risk of death or recurrence, with an adjusted hazard ratio of 1.80 (95% confidence interval [CI], 1.23 to 2.63) as compared with the absence of CHIP and an adjusted hazard ratio of 1.62 (95% CI, 1.02 to 2.56) as compared with CHIP in the absence of TI-CH. Among patients with solid tumors, 26% of those with CHIP had TI-CH. TI-CH conferred a risk of death from any cause that was 1.17 times (95% CI, 1.06 to 1.29) as high as the risk with CHIP in the absence of TI-CH. TET2 mutations were the strongest genetic predictor of TI-CH; such mutations enhanced monocyte migration to lung tumor cells, fueled a myeloid-rich tumor microenvironment in mice, and resulted in the promotion of tumor organoid growth.
CONCLUSIONS: TI-CH increased the risk of disease recurrence or death among patients with NSCLC and the risk of death from any cause among patients with solid tumors. TI-CH remodeled the tumor immune microenvironment and accelerated tumor organoid growth, findings that support a role for an aging-related hematologic clonal proliferation in cancer evolution. (Funded by the Royal Society and others.).

DOI: https://doi.org/10.1056/NEJMoa2413361

N Engl J Med. 2025 Apr 24. 392(16): 1654-1656

Clonal Hematopoiesis as a Driver of Solid Tumors.

Lachelle D Weeks, Benjamin L Ebert.

DOI: https://doi.org/10.1056/NEJMe2504775

Int J Gynaecol Obstet. 2025 Apr 25.

Artificial intelligence in the diagnosis and management of gynecologic cancer.

Chaiyawut Paiboonborirak, Nadeem R Abu-Rustum, Sarikapan Wilailak.

Gynecologic cancers affect over 1.2 million women globally each year. Early diagnosis and effective treatment are essential for improving patient outcomes, yet traditional diagnostic methods often encounter limitations, particularly in low-resource settings. Artificial intelligence (AI) has emerged as a transformative tool that enhances accuracy and efficiency across various aspects of gynecologic oncology, including screening, diagnosis, and treatment. This review examines the current applications of AI in gynecologic cancer care, focusing on areas such as early detection, imaging, personalized treatment planning, and patient monitoring. Based on an analysis of 75 peer-reviewed articles published between 2017 and 2024, we highlight AI's contributions to cervical, ovarian, and endometrial cancer management. AI has notably improved early detection, achieving up to 95% accuracy in cervical cancer screening through AI-enhanced Pap smear analysis and colposcopy. For ovarian and endometrial cancers, AI-driven imaging and biomarker detection have enabled more personalized treatment approaches. In addition, AI tools have enhanced precision in robotic-assisted surgery and radiotherapy, and AI-based histopathology has reduced diagnostic variability. Despite these advancements, challenges such as data privacy, bias, and the need for human oversight must be addressed. The successful integration of AI into clinical practice will require careful consideration of ethical issues and a balanced approach that incorporates human expertise. Overall, AI presents significant potential to improve outcomes in gynecologic oncology, particularly in bridging healthcare gaps in resource-limited settings.

Keywords: artificial intelligence; cervical cancer; diagnostic imaging; early detection; endometrial cancer; gynecologic oncology; ovarian cancer; personalized medicine; robotic surgery

DOI: https://doi.org/10.1002/ijgo.70094

Int J Gynecol Cancer. 2025 Mar 29. pii: S1048-891X(25)00922-3. [Epub ahead of print]35(5): 101805

Multi-center, international endometrial cancer consortium highlights.

The multi-center, international consortium on endometrial cancer held in January 2025 at Mayo Clinic in Rochester, Minnesota brought together leading experts in gynecologic oncology to explore the latest advancements in the understanding, diagnosis, and treatment of endometrial cancer. Discussions centered on key topics, including updates in molecular testing and disease staging, emerging treatment strategies for advanced and recurrent disease, fertility-sparing management, and critical pathology challenges, particularly, the assessment of lympho-vascular space invasion. Each topic was examined in dedicated working group sessions, fostering in-depth exchanges to identify research priorities and develop actionable strategies. This summary highlights the central themes and insights from the meeting, outlining a roadmap for future advancements in the field. By promoting inter-disciplinary collaboration, the meeting laid the foundation for future research, policy recommendations, and clinical innovations aimed at improving patient outcomes.

Keywords: Disease Staging; Endometrial Cancer; Fertility-Sparing Treatments; Lympho-vascular Space Invasion; Novel Therapies

DOI: https://doi.org/10.1016/j.ijgc.2025.101805