Cross-border tumor boards enhance care for rare gynecological cancers across Europe

Cross-border tumor boards of cancer specialists from different European countries meeting virtually to review the management of individual patients with complex rare gynecological 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.

Gynecological cancers occur in the female reproductive system and include cervical, ovarian, uterine, vaginal, vulval cancers and gestational trophoblastic tumors. More than half of all 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 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%). 

Treating rare gynecological cancers poses several challenges in terms of lack of consensus on management or shared guidelines and poor availability of clinical trials. 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."

Alice Bergamini, presenting author, Gynecology and Obstetrics Unit, I.R.C.C.S. Ospedale San Raffaele, Milan, Italy

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. As part of its work, EURACAN G2 organises multidisciplinary tumor 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 tumor boards on patient care over the six years from November 2017 to October 2023. During this time 67 multidisciplinary tumor 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 tumor 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 gynecological 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 centers, 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 tumor boards also help to improve the harmonization 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 tumor boards."

The new findings showing the value of cross-border tumor 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 tumor cancers, from head and neck cancers to those affecting the digestive tract.

"The virtual tumor board approach we are using for complex gynecological 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 tumor boards for patients with sarcoma are now underway and 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 optimizing 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."