Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of gynecologic cancer

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Abstract

Advanced gynecologic cancers have historically lacked effective treatment options. Recently, immune checkpoint inhibitors (ICIs) have been approved by the US Food and Drug Administration for the treatment of cervical cancer and endometrial cancer, offering durable responses for some patients. In addition, many immunotherapy strategies are under investigation for the treatment of earlier stages of disease or in other gynecologic cancers, such as ovarian cancer and rare gynecologic tumors. While the integration of ICIs into the standard of care has improved outcomes for patients, their use requires a nuanced understanding of biomarker testing, treatment selection, patient selection, response evaluation and surveillance, and patient quality of life considerations, among other topics. To address this need for guidance, the Society for Immunotherapy of Cancer (SITC) convened a multidisciplinary panel of experts to develop a clinical practice guideline. The Expert Panel drew on the published literature as well as their own clinical experience to develop evidence- and consensus-based recommendations to provide guidance to cancer care professionals treating patients with gynecologic cancer.

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Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

Hyuna Sung, Jacques Ferlay, Rebecca Siegel … (2021)

This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.

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Cancer statistics, 2020

Rebecca Siegel, Kimberly D Miller, Ahmedin Jemal (2020)

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on population-based cancer occurrence. Incidence data (through 2016) were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2017) were collected by the National Center for Health Statistics. In 2020, 1,806,590 new cancer cases and 606,520 cancer deaths are projected to occur in the United States. The cancer death rate rose until 1991, then fell continuously through 2017, resulting in an overall decline of 29% that translates into an estimated 2.9 million fewer cancer deaths than would have occurred if peak rates had persisted. This progress is driven by long-term declines in death rates for the 4 leading cancers (lung, colorectal, breast, prostate); however, over the past decade (2008-2017), reductions slowed for female breast and colorectal cancers, and halted for prostate cancer. In contrast, declines accelerated for lung cancer, from 3% annually during 2008 through 2013 to 5% during 2013 through 2017 in men and from 2% to almost 4% in women, spurring the largest ever single-year drop in overall cancer mortality of 2.2% from 2016 to 2017. Yet lung cancer still caused more deaths in 2017 than breast, prostate, colorectal, and brain cancers combined. Recent mortality declines were also dramatic for melanoma of the skin in the wake of US Food and Drug Administration approval of new therapies for metastatic disease, escalating to 7% annually during 2013 through 2017 from 1% during 2006 through 2010 in men and women aged 50 to 64 years and from 2% to 3% in those aged 20 to 49 years; annual declines of 5% to 6% in individuals aged 65 years and older are particularly striking because rates in this age group were increasing prior to 2013. It is also notable that long-term rapid increases in liver cancer mortality have attenuated in women and stabilized in men. In summary, slowing momentum for some cancers amenable to early detection is juxtaposed with notable gains for other common cancers.

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Cancer statistics, 2022

Rebecca Siegel, Kimberly D Miller, Hannah Fuchs … (2022)

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes. Incidence data (through 2018) were collected by the Surveillance, Epidemiology, and End Results program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2019) were collected by the National Center for Health Statistics. In 2022, 1,918,030 new cancer cases and 609,360 cancer deaths are projected to occur in the United States, including approximately 350 deaths per day from lung cancer, the leading cause of cancer death. Incidence during 2014 through 2018 continued a slow increase for female breast cancer (by 0.5% annually) and remained stable for prostate cancer, despite a 4% to 6% annual increase for advanced disease since 2011. Consequently, the proportion of prostate cancer diagnosed at a distant stage increased from 3.9% to 8.2% over the past decade. In contrast, lung cancer incidence continued to decline steeply for advanced disease while rates for localized-stage increased suddenly by 4.5% annually, contributing to gains both in the proportion of localized-stage diagnoses (from 17% in 2004 to 28% in 2018) and 3-year relative survival (from 21% to 31%). Mortality patterns reflect incidence trends, with declines accelerating for lung cancer, slowing for breast cancer, and stabilizing for prostate cancer. In summary, progress has stagnated for breast and prostate cancers but strengthened for lung cancer, coinciding with changes in medical practice related to cancer screening and/or treatment. More targeted cancer control interventions and investment in improved early detection and treatment would facilitate reductions in cancer mortality.

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Author and article information

Journal

Journal ID (nlm-ta): J Immunother Cancer

Journal ID (iso-abbrev): J Immunother Cancer

Journal ID (hwp): jitc

Journal ID (publisher-id): jitc

Title: Journal for Immunotherapy of Cancer

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2051-1426

Publication date Collection: 2023

Publication date (Electronic): 9 June 2023

Volume: 11

Issue: 6

Electronic Location Identifier: e006624

Affiliations

[1 ] departmentCancer Vaccine Institute , Ringgold_7284University of Washington , Seattle, Washington, USA

[2 ] departmentDepartment of Obstetrics and Gynecology, Division of Gynecologic Oncology , Ringgold_130373The University of New Mexico Comprehensive Cancer Center , Albuquerque, New Mexico, USA

[3 ] departmentMedical Oncology , Ringgold_29436Tata Memorial Centre , Mumbai, Maharashtra, India

[4 ] Ringgold_232022Homi Bhabha National Institute , Mumbai, Maharashtra, India

[5 ] departmentDepartment of Medical Oncology and Hematology , Ringgold_10051Princess Margaret Hospital Cancer Centre , Toronto, Ontario, Canada

[6 ] departmentDartmouth-Hitchcock's Norris Cotton Cancer Center , Ringgold_12285Dartmouth Medical School , Hanover, New Hampshire, USA

[7 ] A Cottage for Counseling , Palm City, Florida, USA

[8 ] departmentProgram in Women's Oncology , Ringgold_22209Women and Infants Hospital of Rhode Island , Providence, Rhode Island, USA

[9 ] departmentDepartment of Medicine , Ringgold_72058UPMC Hillman Cancer Center , Pittsburgh, Pennsylvania, USA

[10 ] departmentDepartment of Medicine , Memorial Sloan Kettering Cancer Center , New York, New York, USA

[11 ] departmentDepartment of Medicine , Ringgold_12295Weill Cornell Medical College , New York, New York, USA

[12 ] departmentPelotonia Institute for Immuno-Oncology, Division of Medical Oncology , Ringgold_2647The Ohio State University , Columbus, Ohio, USA

[13 ] departmentDepartment of Obstetrics, Gynecology & Women’s Health, Division of Gynecologic Oncology , Ringgold_5635University of Minnesota , Minneapolis, Minnesota, USA

[14 ] departmentGynecologic Oncology and Reproductive Medicine , Ringgold_4002The University of Texas MD Anderson Cancer Center , Houston, Texas, USA

[15 ] departmentDepartment of Medical Oncology & Hematology , Northwell Health Cancer Institute , Lake Success, New York, USA

[16 ] departmentUniversity of Chicago Medicine Comprehensive Cancer Center , University of Chicago , Chicago, Illinois, USA

[17 ] Ringgold_12353University of Washington School of Medicine , Seattle, Washington, USA

[18 ] departmentDepartment of Obstetrics, Gynecology & Reproductive Sciences , University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania, USA

[19 ] departmentDepartment of Pathology , Ringgold_12350University of Virginia Health System , Charlottesville, Virginia, USA

[20 ] departmentDepartment of Gynecologic Oncology , Ringgold_2074Roswell Park Cancer Institute , Buffalo, New York, USA

[21 ] Ringgold_577662The University of Chicago Medicine Comprehensive Cancer Center , Chicago, Illinois, USA

Author notes

[Correspondence to ] Dr Kunle Odunsi; odunsia@ 123456bsd.uchicago.edu

Author information

Mary L Disis http://orcid.org/0000-0001-7653-4648

Jyoti Bajpai http://orcid.org/0000-0001-7657-3460

Tyler Curiel http://orcid.org/0000-0001-6962-9411

Leisha A Emens http://orcid.org/0000-0002-7694-0731

Claire F Friedman http://orcid.org/0000-0003-2621-8553

Margaret Gatti-Mays http://orcid.org/0000-0001-8914-2897

Melissa A Geller http://orcid.org/0000-0003-4591-620X

Amir Jazaeri http://orcid.org/0000-0003-4335-4151

Veena S John http://orcid.org/0000-0002-2688-5447

Katherine C Kurnit http://orcid.org/0000-0003-3205-0128

John B Liao http://orcid.org/0000-0002-3018-7879

Emese Zsiros http://orcid.org/0000-0003-0142-7375

Kunle Odunsi http://orcid.org/0000-0002-4444-7651

Article

Publisher ID: jitc-2022-006624

DOI: 10.1136/jitc-2022-006624

PMC ID: 10277149

PubMed ID: 37295818

SO-VID: 2c7d3fe6-d877-43e5-9181-a4df426ffda2

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See http://creativecommons.org/licenses/by-nc/4.0/.

History

Date accepted : 28 April 2023

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Keywords: guidelines as topic,clinical trials as topic,genital neoplasms, female

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Keywords: guidelines as topic, clinical trials as topic, genital neoplasms, female

Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of gynecologic cancer

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Cancer Immunotherapy

Most cited references 299

Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

Cancer statistics, 2020

Cancer statistics, 2022

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