Objective To evaluate the incidence, risk factors, and clinical outcomes associated with venous thromboembolism (VTE) in patients with gynecologic cancer treated with immune checkpoint inhibitors (ICI). Methods This retrospective cohort study included patients with gynecologic malignancies treated with ICI at a single institution between January 2017 and April 2026. The primary outcome was the development of VTE from ICI initiation through one month after the final cycle. Incidence, clinical characteristics, risk factors, and healthcare utilization were evaluated. Results Among 458 patients who received ICI therapy, 37 (8.1%) experienced a VTE. Deep vein thrombosis was the most common event (48.6%, n = 18), followed by pulmonary embolism (40.5%, n = 15). The median time from ICI initiation to VTE was 1.43 months (IQR, 0.70–2.93). Endometrial cancer was the most common disease site among patients with VTE (54.1%, n = 20). Smoking history differed significantly between groups (p < 0.01). ICI monotherapy was more common among patients who experienced VTE compared with those who did not (64.9% vs. 44.9%, p = 0.020), and patients with VTE had received fewer total lines of therapy (2.4 vs. 3.3, p = 0.008). Most events required emergency department evaluation (64.9%, n = 24) and hospitalization (59.5%, n = 22), and ICI therapy was delayed in 24.3% (n = 9) of cases. Breakthrough thrombosis was observed in 18.9% (n = 7) of patients receiving anticoagulation. Conclusion VTE occurred in 8.1% of gynecologic cancer patients receiving ICI, was early in onset, and carried significant clinical burden. These data can guide provider awareness and patient counseling when initiating ICI in this population.
Low-grade serous ovarian carcinoma (LGSOC) is a rare epithelial malignancy characterized by frequent mitogen-activated protein kinase (MAPK) pathway alterations, hormone receptor expression, relative resistance to cytotoxic chemotherapy, and a prolonged, relapsing clinical course. Since publication of the 2023 international expert consensus, significant advances have reshaped the management of both newly diagnosed and recurrent disease. The 2026 LGSOC Consensus Conference convened an international multidisciplinary panel of experts in the field to review emerging evidence and update recommendations across pathology, molecular testing, translational biology, frontline and recurrent treatment, imaging, treatment-associated toxicity, regulatory strategy, patient advocacy, and future research priorities. Recommendations were informed by contemporary clinical evidence, multidisciplinary discussion, and patient perspectives. The updated consensus incorporates practice-changing data from NRG-GY019 supporting chemotherapy-containing postoperative therapy as the current reference approach for stage II–IV disease while recognizing selected circumstances in which endocrine monotherapy may represent individualized de-escalation. It also integrates recent advances in recurrent disease, including the US Food and Drug Administration's accelerated approval of avutometinib in combination with defactinib for KRAS-mutated LGSOC, emerging evidence supporting endocrine therapy combined with CDK4/6 inhibition, and refined guidance for biomarker-directed treatment selection, imaging assessment, toxicity management, and patient-centered survivorship. The panel emphasizes treatment-specific biomarker interpretation, multidisciplinary care, central pathology review for clinical trials, and the continued need for prospective studies addressing treatment sequencing, predictive biomarkers, and quality-of-life outcomes. This updated international consensus provides an evidence-based framework for the diagnosis and management of LGSOC while identifying priorities for future clinical research and drug development.
Objectives To describe the current landscape of hormone replacement therapy (HRT) to treat surgical menopause following bilateral salpingo-oophorectomy (BSO) in individuals with hereditary ovarian cancer risk in British Columbia, Canada. We aimed to describe current use of HRT, identify factors associated with HRT use and identify potential barriers for uptake and access. Methods Individuals with germline pathogenic/likely pathogenic variants in an ovarian cancer susceptibility gene were identified through the BC Cancer Hereditary Cancer Program (HCP) Progeny database. A cross-sectional survey was administered to collect participant demographics, personal and family cancer history, and participant experiences with HRT. Descriptive statistics were used to characterize the sample and logistic regression used to explore associations between sociodemographic variables and reported HRT use. Open text fields were analyzed using inductive quantitative content analysis. Results In total, 374 responses were received from 1284 potential participants (29.1% response rate). Of participants who have had a BSO, 41% (101/245) report HRT use. In open-text responses, 22% of participants reported lack of support by healthcare professionals and 26% described gaps in counselling about HRT and surgical menopause. In the regression analysis, HRT use was less likely in individuals who: were of increasing age, reported a history of any cancer type and who reported receiving no counselling about HRT (all p < 0.0011 after Bonferroni correction). Conclusion Barriers to HRT access and uptake exist for individuals at increased risk of ovarian cancer. Together this data indicates that patients require additional support in this area particularly as it relates to education and resources.
