జర్నల్ ఆఫ్ ఆంకాలజీ మెడిసిన్ & ప్రాక్టీస్

Cervical cancer is a preventable disease. It is also curable if detected early and adequately treated. Yet it is the fourth most common cancer among women globally. In India cervical cancer is the second most common cancer among women between 15 and 44 years of age. The most common histologic type of cervical cancer is squamous, most common cause is by HPV infection. Cervical intraepithelial neoplasia (CIN) is a premalignant condition of the uterine cervix. Various screening methods are available for diagnosis including Pap smear and colposcopic directed biopsy. However, LEEP (Loop electrosurgical excision procedure) is used for treatment of CIN. Invasive cervical cancer has a long pre invasive phase and hence early diagnosis and treatment can be done.

Objective: This is a prospective observational study of correlation between colposcopic directed biopsy and LEEP in cervical intraepithelial neoplasia (CIN).

Methods: A longitudinal study was conducted on 150 subjects attending Gynecological Outpatient department at tertiary care centre and who met the inclusion and exclusion criteria of reproductive age group i.e., (22-55 years) those were screened for CIN (cervical intraepithelial neoplasia) by VIA(visual inspection via acetic acid) and/or cervical cytology by liquid based cytology. All the patients with positive VIA and abnormal cervical cytology findings were subjected/screened by colposcopy examination and patients with CIN were subjected to LEEP. Kappa statistics was used to determine agreement between 2 test procedures. Spearman’s correlation coefficient (rho) was used to measure strength and direction of association between 2 test procedures based on ordered variables. P value <0.05 was considered statistically significant.

Results: 111 patients were having cervicitis on colposcopy directed biopsy and 39 patients were diagnosed with CIN. The colposcopy directed biopsy and LEEP results were statistically significant in positive patients with CIN. No significant correlation between demographic indices and prevalence was noted in CIN patients

Conclusion: Colposcopic directed biopsy is the gold standard for diagnosis as confirmed by Loop Electrosurgical Excision Procedure (LEEP), also known as large loop excision of the transformation zone (LLETZ), a method used for excisional treatment of HSIL.

Objective: Previous studies have shown that older women are more likely to be diagnosed with gynecological cancers (GC) setting the precedent for more attention to be given to older women than younger women with GC. This study seeks to compare nationally representative healthcare use among younger women and older women diagnosed with gynecological cancer in the United States.

Methods: A retrospective cross-sectional repeated measures design was used to make comparisons between baseline characteristics of two age groups of women diagnosed with gynecological cancers. Data were extracted from the National Health Interview Survey (NHIS). A weighted sample of 2633569 responses who reported having at least one kind of GC was included from 2015 to 2018. GC was defined as those who reported having uterine, cervical, or ovarian cancer. Characteristics of patients were compared across two age groups. 1. Women less than 50 considered to be most likely premenopausal. 2. Women more than 50 considered to be most likely postmenopausal. Nine health services use were also quantified between both age groups and a multivariable logistic regression model was used to determine the likelihood of health care use among both age groups with the older women being the reference group.

Results: Among the baseline characteristics, alcohol use and smoking were seen to be most prevalent among the younger women with the following proportions 88% and 79.93% for alcohol use and 59.79% and 50.26% for smoking at p<0.01. Younger women had higher obstetrics and gynecologic visits OR 2.13 (1.59-2.84), Emergency room visits OR 1.55 (1.17-2.06), Hospitalization OR 1.57 (1.15-2.14), Preventive care OR 2.49 (1.88-3.31). Adjusting for Alcohol use and smoking yielded similar odds ratio. Patterns of hospitalization increased over time for younger women and use of surgery and surgical procedures wasn’t statistically significant among both age groups.

Conclusion: Based on this study, younger women tend to use comparable healthcare services as older women diagnosed with gynecologic cancer. Therefore, more studies should be conducted with the inclusion of younger women.

The reputation of checkpoint inhibitors as potential game changers in oncology is well-deserved as the the 14/14 complete responses recently reported with the PD-1 inhibitor, dostarlimab, in mismatch repair (MMR) deficient locally advanced rectal cancer demonstrates but comes with an important caveat: in most cases and in most cancers non-responders greatly outnumber responders. This begs the question of how to mimic the unprecedented result with dostarlimab in MMR-proficient and otherwise checkpoint inhibitor non-responsive cancers. Several strategies to sensitize tumors to checkpoint inhibitors are under active investigation. These include combinations with other checkpoint inhibitors, chemotherapy, angiogenesis inhibitors, targeted agents, DNA damage repair inhibitors, epigenetic modifiers, and TGF-β inhibitors. This short communication presents data on AdAPT-001, a Type 5 oncolytic adenovirus, currently in a Phase 1/2 clinical trial called BETA PRIME (NCT04673942), which encodes for a transforming growth factor-beta (TGF-β) trap, as an anti-PD-L1 sensitizer.