Hi, everyone. Good morning. I think you are having a good second day start early in the morning, and thank you for coming. So I'm Keiichi Fujiora, and I've been president of the IGCF for the past few years, and it's truly my pleasure to welcome you to the ALI Career Workshop here. So as I look around the room there, I'm filled with hope and happiness for the future of our society, profession, and for the patients under your care in the future. Very, very important. And also, it's good for me to remember that those who came after us were I also want to express my special thank you to Alex, Dr. Oroie, and now Dr. Suzuki and Rhoda, where is Rhoda? Yeah, she is there, okay, who have served as the IGCS board of representing the mentors to the network, this network. So they are here to support you and empower you. Feel free to ask them if you need anything, so they will be 100% supportive to you. So I'd like to also extend my here and I see how committed you are to the network and the all the effort that you have put into organizing today's workshop. So I look forward to seeing how you continue to develop your already promising careers. So today is a good day for you to learn, share your knowledge, and build friendship. This is very important. Having a friend, having the all the sharing with your So we have, so many of you will get to stage and present your abstract. I hope you will have really fun to present your work, okay? All right, so many of you will get on stage and present your abstract, and we have some global experts here for the panel discussion. So ask them questions. Don't be shy and feel free, okay? It's a great, great opportunity to challenge the experts in the world, you know? It's very nice. So I'd like to finally thank you for being here and for your commitment to Thank you for the warm welcome and kind words, professors. Welcome everyone. Good morning. My name is for incident. I'm one of the junior mentors. I'm joined today with Dr. Unfortunately, and Arthur, our junior mentors were unable to join us in Dublin and we miss having them here with us today. So, before we get started with another presentation, I would like to congratulate all of the presenters that have been accepted presenter abstracts today. It's truly an amazing accomplishment and it is clear that you have all such a bright careers ahead of you. We have six oral abstract presentation during today's workshop and a great panel discussion moderated by Dr. Unfortunately, Dr was unable to attend in Dublin with his oral after presentation, and maybe found in the education learning portal. So, let's started with our oral abstract presentations following three abstracts. We will have a time for Q and a, and when white, we invite you all to come to the microphone and ask questions again. Don't be shy as Dr suggested at this time. We will welcome Dr for our first oral presentation. Thank you, Megan. Please join us ahead of it. Can you join us? Yes, please. Join us here in the table. So, our next presentation will be from Aisha Mustafa. Thank you Aisha. Thank you Aisha. Please join us at the table. Our next presenter would be Dr. Shagun Kapoor from India. Shagun, the stage. A very good morning. I am Dr. Shagun Kapoor from All India Institute of Medical Sciences India and I will be discussing on the implications of revised ovarian adnexal reporting and data system for evaluation of adnexal masses and I have nothing to disclose. So multiple ultrasound based reporting systems have already been introduced for better risk stratification of adnexal masses and we all know that ORADS the original version was introduced in 2019. The studies have demonstrated high sensitivity but the specificity has varied from 46% to 92%. To address this particular limitation ORADS 2022 version was updated and multiple terms like multilocular cyst and solid smooth lesions were introduced. However, since there is a scarcity of studies on the diagnostic accuracy of this updated reporting system we conducted this study to evaluate the diagnostic efficacy of the version 1 and the 2022 version for better discrimination of adnexal masses. So coming on to the material and methods this was a retrospective observational study conducted in a tertiary care institute and the ultrasound imaging of adnexal masses were done in the women who underwent surgical management from 2021 to 2022 to 2023 and this was applied by two different clinic oncologists with more than 15 years of clinical experience. The index test under study was ORADS version 1 and 2022 and they were compared with a reference standard that is the histopathology. So briefly talking about the demographic and ultrasound features of these masses as we can clearly see that CA 125 and other ultrasound markers of malignancy like solid component, ascites, increased vascularity was statistically significant for predicting malignancy in these masses but what I'm more what I'm more focused about here that we'll be talking about the distribution of masses in the ORADS version 1 and the ORADS version 2022 in the various categories. So there are five categories and we can see that there is no difference in the number of masses in the category 2 and 5 but we'll be talking about the category 3 and the 4. So in the ORADS version 1, 21 masses were allocated in category 3 which represents less than 10 percent risk of malignancy and 49 masses were allocated in category 4 that demonstrates 10 to 50 percent risk of malignancy but after the introduction of this update 12 masses were reclassified in the updated ORADS version and they were downstaged to a lower risk category. So here we can see that these 12 masses constituted 38.7 percent of the multilocular masses. This further had an impact on an increase in the probability of malignancy in these categories. In the version 1, 53 point there were the probability of malignancy was 53.1 percent in category 4 but after this update it increased to 70.2 percent which means more malignant masses were included and less number of benign masses were there leading to less false positive cases in this particular category. This also led to an improvement in the specificity of the reporting system from 61.7 to 81.7 percent and a further increase in the positive predictive value of this reporting system and we can clearly see that the ROC curve shifted to left in the upper quadrant and had a better area under curve and led to improvement in the diagnostic efficacy. So on further when we studied with the histological characteristics of these reallocated masses and the ultrasound characteristics we saw that due to introduction of the term bilocularity in the 2022 reporting system 12 masses were reclassified in category 3 which mostly constituted the mucinous cyst adenomas the endometriomas and the serous cyst adenofibroma which were previously falsely being classified in an ORADS category 4 just due to the diameter of the lesion. As I can show you in this presentation this ultrasound image this was this is a there's a single septa which was previously classified as a multilocular lesion in the ORADS version 1 but after the update and introduction of term bilocularity in 2022 version we can simply downstage them to category 3 and that improves the diagnostic accuracy of the entire reporting system. Another term known as smooth and solid lesions has also been reintroduced in this reporting system. So I would like to conclude by saying that the updated ORADS 2022 version enhanced the specificity and diagnostic accuracy but it did not alter the sensitivity and it decreases the misclassified masses in the categories 3 and 4 which were mostly the mucinous cyst adenomas the endometriomas and the cyst adenofibromas and this advancement of over the ORADS version 1 strengthened our ability to accurately identify all these masses. Thank you. Thank you. Thank you Shagun. Please join us if it's able to please. We encourage questions and you may come from the floor and to the microphone to ask if you if you want. Good morning. Hi. Good morning. My question is for Dr. Nwandi. I don't know if I'm saying that right. Thank you that was a great talk. All of you great talks but I was wondering you know I think there was some gasp over here that you screened 13,000 women in the two years like amazing work. I was wondering if you guys have any data on how the sensitivity of the self swab compares to the sensitivity of a physician swab and secondarily how the prevalence I think you had like 4.6 or 4.7 percent how that compares to previous data in your region. Is that like pretty standard? Yes we do have a previous publication also on screening and then we have compared it with VIA that is a visual inspection anaesthetic acid. So we have our published data and approximately it's less than 10 percent like whatever we get the HPV positivity results as compared to previous and now. So at least this HPV cell sampling was more acceptable for the women that was a positive point but exactly we could not you know tell the statistical analysis could not be done properly because we did screening in a lot of you know this rural areas. So the population is also not very good so we don't exactly know exactly how many women are there. So but most of them however acceptable to this more than 90 percent came for the camps and they were acceptable with HPV swab and we got a good result also. Perfect thank you. Dr. LaRouze is asking a question. Thanks. First of all congratulations we are we were in the frontline we were touched your job is incredible all of you congratulations. I have a question for for all of you basically but starting from screening this is an incredible achievement because respect the privacy of the patient and I understand that this is a cultural problem that should be taken into account. Don't you think that this available example can be extended in other hospital not only in your country but in all low and middle income country and this should be a good discussion with the government to support this kind of initiative. Yesterday during the master session in cervical cancer we celebrate eight percent increase in overall survival in locally advanced disease but this can save million of life and I think this is the aspect on which we have to work on. That's true ma'am even there's a project going on in our hospital on this urine samples with HPV test so we are correlating the self-sampling HPV test with the urine samples because giving a urine sample for a woman is more acceptable as compared to HPV cells fab also because she knows that nothing is going to be inserted in her vagina for that matter so and we are getting very good results so hopefully within like few years we'll be able to do that and we should I think sit with the government and talk about that because clearly I feel WHO 2030 goals we are not like very close to them in achieving them so we have to discuss about this more. Thank you. Well thank you all. I don't know if there is one more question yes. Good morning. Thank you to all the presenters. Wonderful presentation. My question is to the first presenter. Yeah a good job but those that were positive with HPV and then they didn't come for follow-up. What were the efforts? I mean was any effort made? Yes we actually keep conducting our camps again and again so our social worker team is very good so they keep calling them at least we try to convince the husbands like you need to counsel their wives to come for the checkups so we are doing that. Okay. Hi excellent presentation. I had two questions but you've answered the first one it was about the screening. My second question is to the second presenter. So some interesting work you presented. My question is to do with the adoption of the ERAS program. What are the key barriers you've noticed? I know cost is one of the things but then if you can give just a couple three more barriers to rolling out this program in your hospital. Thank you very much. For us our major barrier for rolling out the ERAS program is just the acceptability by the health care workers is such a big issue even amongst the doctors in the gynecologic oncology units, the nurses, the dieticians, everyone, even the anesthetists. So what they advocated at the commencement of the fellowship program is if we can get local data to kind of convince them that we can do this local data to kind of convince them that okay this thing works, it doesn't increase complication rates, you know the early discharge, the initial commencement of oral feeding, all those things are barriers that they don't even want to talk about. So with this and even more because we intend to extend it for our next patients up to 100 if that will serve as a convincing evidence enough for them to accept it. So it's actually cheaper because the patients tend to go home earlier and everything but the health care providers are just not convinced enough to fully adopt ERAS in my setting. It's a cultural change isn't it? It's a huge change and change is really difficult. Just a piggyback question to that, do you have any feedback from patients with respect to the experience because it's leaving hospital early isn't it, eating earlier than they would have? Yes like when they come for follow-up they just tell us but we have not documented that in a study but looking at it I think we should. But to be very honest the patients are very happy about ERAS. I remember a student that actually had exams on Monday, she got operated on Thursday, was able to go home in two days and she wrote her papers on Monday. So she came back a university undergraduate and she was really happy with the management. So I think we should document that as another aspect of it. Thank you. Thank you very much. Good morning everyone. My name is Sakina from Nigeria as well. Thank you Dr. Aisha for the wonderful presentation and all the other presenters. So with regards to ERAS, I want to ask your experience on how the anesthetists accepted the recommendations in ERAS about delaying admission for patients and then the drugs you can use in trial. Because I'm trying to do the same thing in my hospital in southwestern Nigeria and I'm having some challenges with the anesthetist. Can you share your experience on this? Thank you. Thank you very much. So not just the anesthetist even though we know that they contribute a very huge barrier to it and usually because we couldn't adopt all the domains for ERAS, we just started with nine. And the main thing that had to do with the anesthetist is the less fasting and then non-use of opioids in the post-operative period. So for them, we do not have any like recommendations. We have not adopted for the intra-operative medications they give except that we do antibiotics at induction of anesthesia which they are very comfortable with. But the post-operative care is when we try to reduce as much as possible the use of opioids and then early commencement of feeding. Well great. Congratulations again. Thank you all. Unfortunately this is all the time we have for questions. I am excited to our next session that will be the panel discussion with Dr. Narim Alborostoum and Dr. Domenica De Russo, moderated by our network mentors Dr. Nafossouki and Dr. Alex Olahoui. This panel discussion is aimed to ask questions related to research careers. We invite you to ask these team panelists questions about their careers and allow them to share their expertise and guidance towards our own careers. Please join me and welcome our panelists and moderators. So, thank you for that very nice introduction, and congratulations to all the presenters. We are very happy to have our experts here, Dr. Nadim Abou-Rostoum, our incoming president, and then Kata, Dr. LaRusso, who is a world-famous oncologist. Please ask them questions about milestones, challenges, achievements, and how they maintain a healthy work-life balance, which Dr. LaRusso already answered, but she's going to be answering again. Thank you. So, this is an interactive session, and we encourage audience participation, so just feel free to go to the microphones to ask our panelists their questions. Hi, good morning. This is Nao Suzuki, one of the mentors of the ARICARE network. So, congratulations, good presentations for three. So, now we encourage you to take advantage of this panel today and truly ask questions that could be of benefit to your own careers. This is such a wonderful opportunity. So, anybody first ask the panelists. Don't be shy. Yes. Once again, I'm Waliak from Nigeria. Yeah, I'm a gynecologist, but aspiring to be a gyne oncologist. I would like to know how, I mean, like baby steps, how to start and how to maintain my footings as I go ahead in the career. Sure. So, thank you for being brave and asking the first question. So, you are currently an OBGYN resident. You're a consultant, and you want to go into oncology. So, well, thank you for making that choice. I think it's wonderful that you decide to do that. I think, depending on the institution that you're in, or you're in Nigeria, so I'm not completely familiar, but we have more experts from Nigeria on the panel. I mean, for us, for example, in the United States, when you make that choice, I think it's wonderful. You usually have to go through application to join a fellowship program because there's a structured program for us to become a GYN oncologist. It can be a challenging process because there's a limited number of individuals that can be formally trained, but it's very much worthwhile. And I think the most important message I would say to somebody who's trying to join is, you know, be prepared for some disappointments. Sometimes you may not get in right away, but there are other pathways that you can continue with this journey. In our institution, we interview maybe 70 or 80 candidates, applications. We bring 20 for a more in-depth interview, and we take three. So, you know, the odds are, you know, sometimes not incredibly high, but there may be some good candidates who do not match immediately, but there are other pathways to do one or two years of research and then continue the journey in oncology. So, again, you know, depending on what's available in Nigeria, I would encourage you to continue down that path. Seek a clinical training program, but if not immediately available, maybe find an ability to work in research to become more familiar with GYN oncology and continue with it. We have the same pathway in Italy. You have to apply for this fellowship and then, but I want to add something because you are a woman. I am a woman too. I think it is a global problem, but I will tell you what is the situation in Italy. In this moment in Italy, 70% of students in medicine are women, but only 15, 1, 5% reach a chairing position, apical position. As a woman, you should be prepared probably to find more obstacles, which are related sometimes, I think, quite all over the world, but my experience in Italy, women take care of family, take care of job, and in our society, women have a lot of commitment. There is less, with respect to other society, there is less distribution of job at home between men and women. So, for a woman that wants to have a career, at least in Italy, sometimes the burden of the family commitment may be an obstacle. How to solve? Life is made of choice, and choice may change over time. Life is made of priority. Your priority at 30 is not exactly your priority at 50. I think that the secret is to always follow your priority. This will avoid a lot of frustration. If you, all of us have regrets in life, it's quite normal, but if you follow your priority, regrets will be much more manageable. Thank you. So, unlike the US and Italy, and some few Western European countries, most places in the world actually do not have formalized gynecologic training. A lot of practicing gynecologic oncologists are people that are fortunate in those countries to be affiliated with somebody who, for some good reason, has been able to gain experience in doing gynecologic cancer surgery and taking care of gynecologic cancer. So, my advice for you, specific to the situation in Nigeria, is your best opportunity is to learn by some type of apprenticeship. So, if you can find a nearby large center where there are people doing gynecologic cancer work and find an arrangement that can make you go to them, you know, work with them, operate with them, and see patients with them, that way you can kickstart that, you know, gynecologic oncology pathway. And then you're doing the right thing. You are the IGCS. Come to these conferences and network with other people from other places. Good luck. Good morning. Navya and I are from Miami. First of all, thank you for being here this morning. This is such a wonderful opportunity to get advice from you directly. My question is sort of a two-part question. As many of us transition from early in our career where we take research opportunities that are given to us to a place where you're figuring out your priorities and knowing what you want, how did each of you figure out what your research priorities were? And the second part to that question, when an opportunity came up that wasn't in line with you, your priority, how did you navigate that? I will start with the first question, not go to the second. So, how to prioritize research, it depends on what you want to do. My aspiration was to make women live longer and better, possibly. And that's the reason why I choose to dedicate to the medical part of GYM oncologist. I mean, the experiments of new drugs and new treatment opportunities. To me, this represented the most important antidote to burnout. Particularly when I was young, I was treating a platinum-resistant patient. It was a history that I saw so many times. I knew the end of the history anytime that the patient recovers platinum-resistant. And this was a huge burden, psychological burden to me. So, clinical research to me is the greatest antidote to burnout, which is an important point. There is a clinical research in Europe, 70% of young oncologists have burnout. What is the antidote? Clinical research, I mean, the curiosity to know if a new drug, a new surgery, a new opportunity may change the natural history or may make that patient live longer and live better. And that was for me, my polar north. So, thank you for the question. You know, when you start out doing research, it's actually very hard. It's not easy when you're a resident or just starting in fellowship to actually come up with research projects. You're very busy learning the medical aspects of things, surgery, chemotherapy, radiation, taking exams. So, to really focus and find a good research project is very hard. I think elements of this are, one, try to ask yourself, what problem are you trying to solve? You know, and that's really a good way to start with research. And those questions usually come up every week at your treatment planning conference, at your disease management team. You're faced with situations on the floor, in the operating room, in adjuvant therapy, and find a unique, specific problem that you see happening again and again. And that could be a starting point for research. Of course, you need to discuss it with people who have looked into this question. So, don't try to start from scratch. Many times what you think may be a completely new question has been addressed multiple times in the past. So, do your homework to see who worked on this before and try to learn from them. I think if you keep the question very, very specific and very, very focused, like some of the presentations that we said, they were very, very focused, trying to validate the new ORAD system, trying to see if ERAS works in that environment, trying to see the feasibility of cell, very, very specific. So, those were perfect projects that are just very unique and specific. So, I usually say, what problem are we trying to solve? Keep it very simple. Keep the data very clean and simple. Your question is if you're approached about a project that you may not be completely interested in, my advice, and some of our fellows are here, if we work on a project and at some point, even a few months into it, we're not very happy with how things are going, you're not happy with the quality of the results, you're not happy with the quality of the data, pull out. Don't do it. Because once you put your name on a paper, it's there forever. So, you always want to be completely committed to what you put as research as the highest quality, something you can live with forever. So, it's okay to start a project and say, you know, this is not going in the right direction or this is not for me and probably better do it sooner than later. But you know, in clinical reality, in our daily practice, not only we can choose, sometimes we have to do things that are annoying, but we have to do it. It's part of our job. It's part of the burden, but it's also part of the beauty of our job. Thank you. Any other questions? Hi, good morning, everybody. My name is Gabriel. I'm a fellow in McGill. I want to thank you for the opportunity to ask a question for you. My question is about navigating your early career as a PI, maybe in clinical oncology studies. How do you navigate yourself up to getting to the clinical trials? How do you navigate your pharma interaction? I would appreciate your thoughts. That's great. I think that the answer is to have a good team. You cannot do everything by yourself. You can be very fast if you are alone, but you cannot go very far if you are alone. If you want to go far, if you want to leave a sign in the literature, in the history of medicine, you have to have a good team, people that trust you and people in which you trust. It's not easy. It's not easy because sometimes you are, it was we were discussing with Nadine before the starting of this session, I changed position 10 months ago. I move in another hospital. And when you move in another hospital, you spend a lot of time in building a team, which is the first thing that you have to do. But if you build a strong team and trust, need time, trust, need time is not something that you built today for tomorrow. Trust, need time. But if you spend the time and effort in building a team of people that have your vision, because the difference between a boss or a leader is the capacity to bring people in your vision. And to do this, you need the time and you need the dedication. But if you are able to do that, you can do everything because it became a second family. My team in the hospital will became over time a second family because when you spend 12 hours of your day at work and 12 hours at home, at the end, you have two families. So that's the reason why the team is absolutely important. Completely agree. And I would also say, you know, be patient a little bit, you know, and you're basically on a journey now. This is not something that's going to finish in six months or a year. So all of us, we've made this commitment. This is basically our professional career. So it takes time. And, you know, it may take more than you think. You know, it may go five years without you really feeling that you've achieved what you want. But eventually, I think if you play by the rules, if you have a good supportive team, if you do the right thing, and again, there is some sacrifice in what we do. As Keta was saying, sometimes you may have to do things that you're not completely loving, but you have to do it because you're a good citizen, you're a good team player. That is recognized usually by your leaders, by your people who can open more opportunities for you. So give it a little bit of time and I think eventually things usually will work out. Unless you're in an environment that you think is very toxic to you, that's a completely different discussion. And then sometimes you have to make a decision early on in your career that this department or this environment is not a good fit for me. And that usually you have to discuss with your advisors, with people who you trust and make a decision. But hopefully most of us are in environments that will give us an opportunity to thrive. Thank you. We have time for maybe one more question. Somebody got up before you. We'll take two. We will be fast in the answer. Thank you so much for guiding us. I just wanted to ask one question. In your early career, how did your mentors shape your career and what advice would you give to us as new clinical residents to maintain a meaningful and impactful mentor-mentee relationship with our mentors? I was very lucky in my career because I had a mentor that was really a good person, that gave a lot of space and this is important to build a career. But it's not always the same, unfortunately. And we have to be very honest. Not all the situations are the same. So coming back to what Nadine was saying, it is very important that you feel comfortable with your team and with your mentor and the position in which you are. It is very important. If you are happy, even though you have to accept to do things that sometimes it's necessary to do but you would not, but if you are happy and you are comfortable, that's your place. If you are not happy, you have to be so brave to change. Brave and you have to take into account that change means a lot of job, a lot of fatigue, but it is necessary. We are full of people that claim but do not change because they are not enough brave to change. I think this is an important message for you that you are young. Follow your principles. Always in any situation, follow your principle. Defend your patient. Whatever it takes, defend your patient. This is our mission. And be so brave to change if you are not in a comfortable situation. Be honest with your mentors. Be honest with your colleagues. Try to have friendship. I was listening to what Kiki told this morning. Friendship is important. When you spend 12 hours at job, you cannot have a fight in the job environment. You have to have people that are friends and people you trust. Very good point. Good morning, everyone, once again. My name is Sakina from Nigeria. I first of all want to appreciate Professor Aburustrum and Dr. Alawaye for the – you are currently involved in some training of fellows in Nigeria, and I want to appreciate that. Having said that, I have two specific questions about the IGCS pre-invasive disease program. So, we get to do this course online, and then the hands-on training onsite at the conferences. Now, the challenge with that is that even having done the training at the conference – for example, I attended the last year conference in South Korea. So, you do not get certification from the IGCS. You do not get – so, you do not get certification until you have done some corpus copies and some mentors have said, oh, you're good at this. But the challenge we have back home in Nigeria is there is no mentor. For example, the IGCS does not say, when you finish this training, liaise with so-and-so person back home who will validate what you have done. So, most of the time, we are just left hanging. And this – there are opportunities to network, meet people here, but still, you are not able to complete the course. So, is there something that can be done? For example, is there – can we widen the network of mentors in Nigeria such that more people are able to do and complete this program? Because it's quite necessary back home for more people to be trained in management of pre-invasive disease. The other question is on the IGCS fellowship program. I remember when I joined IGCS a few years ago, I think I've seen one or two adverts. But in the last two or three years, there has not been any advertisement for application for fellowship. So, I'm wondering if this is in the pipeline and how soon it's going to be. Thank you so much. I think it's great feedback on the first question of pre-invasive. So, I think we can certainly do more with that and your feedback. We may have to have a little bit more conversation offline with you to come up with some specifics. I know that we are planning more hands-on, meaning individuals from IGCS, you know, going in person and working in Nigeria for a week or two to supervise and do cases, et cetera. So, we can talk more about that offline. The fellowship program is still ongoing. I think it just goes into cycles. So, the intent is to actually grow it and continue to do that and include as many sites in as many countries as people want to. I think, you know, we've had good meetings yesterday with colleagues from Kenya and Nigeria. So, this is definitely still alive and well, and I think we will continue to offer and grow this program. I think one solution to the problem is, you know, a lot of us are international mentors, but we actually are developing a pool of local mentors. Unfortunately, obviously, availability is the limiting factor for that, but that's the area we have to continue to work harder to expand the number of local mentors that can be available to you to help when you get back home after obtaining that kind of training. But I am afraid that that is all the time we have for today's panel discussion. Thank you all for your questions, and thank you, Nadim. Thank you, Keita, for sharing your expertise. I really appreciate it. Thank you, Alex. So, we now invite Geert, Florencia, and Asi back to the stage for our final three presentations. Thank you, Dr. Oluwaye, Dr. Suzuki, Dr. Abrustam, and Dr. Larusso. We still have three more abstracts to be presented. I invite Dr. Isha Shenbak to share her oral abstract, please. Good morning everyone. I'm here to present my work on pressurized intraperitoneal aerosolized chemotherapy that is PIPAC with escalated dose versus intravenous chemotherapy for peritoneal metastasis in platinum-resistant ovarian cancer, a single center randomized control trial. I have nothing to disclose. So we all know the platinum-resistant ovarian cancer is linked to unfavorable prognosis with poor survival even with multiple lines of chemotherapy. So they uniformly show low response rates even with various chemotherapy agents. So the patients are more willing to undergo newer therapies for modest gains. So here we have PIPAC which is a novel drug delivery technique. It's an innovative treatment option which offers the advantages of it being a daycare procedure, no systemic side effects, better quality of life and a daycare procedure. So it's a safe feasible and a tolerable treatment option which is shown potentially similar or a higher efficacy when compared to the systemic chemotherapy. So ours is an interim analysis data. So the primary objective being the response rate and the secondary outcomes were the quality of life and the morbidity. So we included the platinum-resistant ovarian cancer patients who had received at least one line of chemotherapy in addition to the adjuvant regimen, aged more than 18 years with a good performance status who were not eligible for curative surgeries and after obtaining a consent. We excluded those who had a severe systemic morbidity, who had a history of allergic reactions to platinum-containing compounds or who were in obstruction or who had extraperitoneal systemic metastasis. So after selecting these patients, we had a multidisciplinary tumor board meeting, then had a baseline imaging done and these patients were randomized into either a PIPAC arm or the systemic chemotherapy arm. So the PIPAC arm patients were received three cycles of chemotherapy that is the doxorubicin 3 mg per meter square followed by cisplatin 15 mg per meter square. This was the escalated dose and the systemic chemotherapy agents were at the oncologist discretion and the imaging was done at 8th, 14th and 20th week for response assessment. So this was the OT setup of the procedure for the PIPAC which was done based upon the consensus guidelines for the ISS by according to the ISSP guidelines where the chemotherapy is sprayed using a special injector and 67 percent of our patients had the camera port inserted at the left hypochondrium and the assistant port site 70 percent as at the left lumbar region. Inaccessible areas were the right hypochondrium or the epigastrium and biopsies following a staging laparoscopy was usually at the right paracolic gutter that is the right lumbar region. So coming to our results, 75 cases of patients who received PIPAC and 75 in IV chemotherapy arm, all the demographic data characteristics were comparable. Nearly 70 percent of the patients had at least one previous surgery and in the PIPAC arm 70 percent of the patients received three cycles and in the IV chemotherapy 58 percent of the patients completed six cycles of chemotherapy. So coming to the response rate assessment based on the resist criteria, we see that with the PIPAC 21 patients had complete response in contrast to the IV chemotherapy where no patient showed complete response. So the response rate including the complete and the partial response 62.6 percent had a response rate in PIPAC arm when compared to 22.6 percent in the chemotherapy arm and the peritoneal biopsies which we took following the following the staging laparoscopy in the PIPAC arm which we graded based upon as the PRGS 1, 2, 3 and 4, 1 showing complete response to 4 showing no response. We see a dramatic uh results here with 22 patients showing complete response and 28 patients showing major response. So this is the laparoscopic and the imaging depiction with following PIPAC 1, 2nd and 3rd cycle showing significant response. And coming to the quality of life, again with the functional scale, the symptom wise and the global health scale, PIPAC had a significant improvement at day 120 and at day 180. Coming to the complications, the grade 3 or 4 based upon the clavendendor complications, IV chemotherapy had a significantly higher rate when compared to the PIPAC arm. So that was only about 10 percent in the PIPAC arm. So I would like to conclude that PIPAC is a safe, feasible and easily reproducible treatment option with no post-operative major toxicity and with good tolerance. It often maintains a good quality of life in patients with advanced peritoneal carcinomatosis and it can be considered as an effective option in palliative setting for those who are not candidates for curative resection. So these are my references. Thank you. Thank you, Isha. Please join us at the table. The next abstract will be presented by Dr. Alvaro Ovando. Good morning, everybody. My name is Alvaro Ovando. I'm from Guatemala. I have nothing to disclose and I'm going to show you or share with you the results of our on how we started doing the Sentinel lymph node with fluorescence guided surgery using indotamine green in patients with endometrial cancer in our institution. To provide some context for where the study were performed and for where I'm from, Guatemala is located in Central America, has a population of 18 million people and we are around 20 to 30 gynecologists, oncologists. There are five institutions that provide oncology treatment in the public health system and one of them is a social security system. The primary endpoint was to describe our capacity to detect the Sentinel lymph node and to determine the most frequent location. It was a prospective and descriptive study and inclusion criteria, patients diagnosed with endometrial cancer by biopsy, regardless of the histology, who were candidates for minimal and basic surgical treatment and underwent Sentinel lymph node mapping with indotamine green. All the patients provide written informed consent and the ad hoc committee of our institution approved the protocol so we include 14 patients. We use indotamine green dye, 2.5 milligrams per milliliter, 1 cc superficial and 1 cc deep at the cervical stroma level at the 3 and 9 o'clock orientation and all the Sentinel lymph nodes were sent to preoperative analysis to confirm lymph node tissue. As a part of the protocol, the institution requested us to do a systematic pelvic lymphatic anectomy in all the patients after the Sentinel lymph node and if this was negative, the ultrastaging was performed and if the ultrastaging was performed, no additional treatment was followed. The data we used were obtained through absolute and relative frequencies and descriptive statistics. About the limitations, at the beginning it was difficult to obtain the indotamine green dye and a big limitation was that not all the attending physicians are trained to perform minimal invasive surgery. In this result we're showing over here in this table, we detect the Sentinel lymph node in the right pelvis in 12 out of the 14 patients and in the left in 10 out of the 14. The most frequent location was the internal iliac vessels and only one Sentinel lymph node was reported with macrometastasis which also identified in the pelvic lymphatic anectomy and now the ultrastaging reports were negative too. So we detected in 13 cases the Sentinel lymph node with detection of 86% on the right side and 71% on the left side and the most frequent location was the internal iliac vessels. The average number of Sentinel lymph node was 1.14 on the right side and 1.71 on the left side and the main histology result was endometrioid adenocarcinoma in 92% of the cases. In the conclusion, the detection of the Sentinel lymph node in patients with endometrial cancer is an appropriate technique that requires a learning curve but is reproducible and achievable in our institution. Thank you to all the patients and to emphasize that this is teamwork. So thank you to my colleagues and my attending physicians and thank you. Thank you, Dr. Urbando. Please join us at the table. Our final abstract presentation will be presented by Dr. Upa Sanapavlo. A very good morning to everyone. So I'd like to present my study on first-line Rukaparib maintenance after hypothermic intraperitoneal chemotherapy with interval debulking surgery for advanced epithelial ovarian cancer, a real-world study. I have nothing to disclose. There are several randomized control trials which have shown that first-line PARP inhibitor maintenance after surgery and platinum-based chemotherapy improves survival in advanced epithelial ovarian cancer. HIPEC with interval debulking surgery has also shown survival benefit in advanced ovarian cancer in several phase 3 randomized control trials. However, there is limited evidence of PARP inhibitor maintenance after interval debulking surgery with HIPEC. The present study aimed to evaluate the outcomes of Rukaparib maintenance after interval debulking surgery and HIPEC in Indian women with advanced epithelial ovarian cancer. So this was a retrospective single institutional study conducted at Tata Medical Center India from January 2021 to December 2023 where we followed up the patients with who underwent IDS with HIPEC and they were given Rukaparib as a maintenance therapy for a maximum period of two years and they were followed up and the median follow-up time was around 21 months. We had 25 such patients. Looking at the baseline characteristics, these patients had aged from 36 to 77 years with a median age of 52 years. Majority of them had stage 3 C disease and almost all of them had high-grade serous ovarian cancer. We were able to achieve a CC0 score in 92% of the patients and 76% of them had some form of BRCA mutation and non-BRCA HRR gene alteration was noticed in 20% of these patients. Looking at the survival analysis, the median progression free survival was 29.9 months. The median overall survival was not reached. The estimated overall survival was however 81%. Looking at the adverse events, so treatment, some form of treatment related adverse events of grade 3 or more occurred in around 60% of the patients. If we look at the curve, anemia accounted for the most common adverse event with Rukaparib followed by neutropenia, hepatic enzyme elevation fatigue and thrombocytopenia. Rukaparib dose reduction was required in 72% of the cases and however, discontinuation due to treatment related adverse events were required in 12% of the patients. It's important to note that there was no treatment related mortality with Rukaparib maintenance therapy and we did not have any patient who had AML or MDS after Rukaparib maintenance therapy. To highlight the strengths of our study, this is the first study of its kind in Indian women which combines two existing standards of care and we have, we are presenting a data from a high-volume HIPEC center with a stringent selection criteria for HIPEC. This is the first of its kind real-world data with a single part inhibitor maintenance. However, we had several weakness because this was a small size single arm retrospective study and had potential bias due to differences in treatment accessibility and this is the data from a single comprehensive cancer center so it may not be representative of the real world and non-BRCA or HRR population was not adequately represented in our study. So, if we look at the other studies, so we know that we have phase 3 randomized control trial that is the athena mono which showed a median PFS survival of 20.2 months with Rukaparib maintenance and then we have the ov-HIPEC trial which showed a survival benefit of a progression-free benefit of 14.3 months with interval debulking surgery and HIPEC. Our current study combined these two study that is interval debulking surgery with HIPEC followed by Rukaparib maintenance and here we present to you a progression-free survival of 29.9 months. There are several phase 3 randomized control trials looking at the same aspect namely the HOT by the GOG Foundation and the Cov-HIPEC 04 which looks at IDS-HIPEC followed by Liraparib maintenance and IDS-HIPEC followed by PARP inhibitor or Bevacizumab maintenance respectively. To conclude, first-line maintenance Rukaparib after hypothermic intraperitoneal chemotherapy with interval debulking surgery for advanced ovarian cancer has encouraging survival. The study reported no new safety concerns however most of the women did require Rukaparib dose reduction so this approach of combining HIPEC with PARP inhibitor in the first-line treatment of ovarian cancer does merit further evaluation in randomized studies. Thank you. Thank you Dr. Pallu. Please join us at the table and we might have time just for one question if there's any from the audience. Thank you for your talk, and I'm Dr. Xia from Taiwan. I have one question about the PIPEC. About the PIPEC, your dose seems to be a little bit higher than the reported dose about doxorubicin. The dose? Yes, yes. You used the three properly. Yeah, the previous dose was doxorubicin of 2.1 and this is platen of 10, yes. So you mean the three milligram is the higher dose in your escalated dose, right? Yes. So the starting dose is 2.1 or 2.5? All the same? We have seen increase, objective response rates are increased. So earlier with the recommendation as per the guidelines is 2.1 and 10, which has shown in our previous study, which is published, the response rate of about 50%. And in ours with an escalated dose, there is no much increase in the side effects. The tolerability is good, but the response rate has increased to 60%. So you used 2.1 in the initial, then escalated to 3, okay. So another is that you give the doxorubicin first, then followed by cisplatin. So you did not give the medication simultaneously, you know, some type of do it simultaneously. You have two tubes, right? So the medication is given simultaneously. You did not give simultaneously, you give it. Yeah, we initially give doxorubicin, then followed by cisplatin, and then give a rest period for 30 minutes. How about the interval between the two medications? No, we don't. We actually also have a double injector. If that is there, if that we use, then we can use two drugs simultaneously also. So another follow-up, by you, you have one, you can do doxorubicin, then followed by cisplatin? Yes. Okay, thank you very much. Thank you. Thank you very much for the excellent presentations. My question is with BioPak as well. So in your cohort, what disease groups did you have who had the peritoneal metastasis? I don't know if you mentioned this earlier. We included only platinum-resistant ovarian cancer with peritoneal metastasis. So those who would record less than six months following the first adjuvant chemotherapy. Okay. And with your previous data, because the reason for the escalated dose was to see if the escalated dose was more efficacious. Yes. And looking, because 50% and 60%, yes, it's just a bit more. But looking at the characteristics of your patients, were there any differences to point to why you had this increase in efficacy related to the escalated dose? Do you have more stage threes and four in one compared to the other, or are they similar across board? No, it's similar with the traditional dose as well as the escalated dose. We use the escalated dose to see if the response rate is better and if the side effects also. So just to compare that, but in our study, we found that the tolerability is quite good. So it is comparable to the previous dose itself, but the objective response rate had significantly increased. Okay. And with the number of patients who completed the three cycles of PIPAC in both cohorts, are they the same, or did you find that there were differences? No, we have actually not compared the traditional agent with the escalated dose. We've compared with escalated with the IV chemotherapy, but the cohort is the same. Okay. Thank you. Thank you. Congratulations to all three of you. Last question, yeah. And I'll wrap it up here. My comments are for the other two presenters. For the sentinel node study, it would be really nice for you to describe, because you have the data, your sensitivity and specificity, and that's definitely something that would be worth publishing. And then for the recaparib study, one comment is just that everyone in your study was HRD, so they tend to do better. So it's hard to compare with OB-HYPEC1, because those are more of an all-comer population. And as you think about designing your randomized control trial, is it really the recaparib that they're benefiting from, or is it the HYPEC, and how do you tease that out? So just some food for thought. Congratulations. Thank you. Thank you all. This is all the time that we have for the workshop. We have a lot of exciting sessions coming up. I'm signing off as a junior mentor this year. I've been part of the Early Career Network for the last four years, and it's been an amazing journey. The network is growing stronger and stronger, and all of us thank you all for your commitment for the network. We have five new junior mentors who are coming up, and it would be great to see how the Early Career Network strengthens and shapes up in the future. Thank you. Thank you all, and I agree with Gitu. It will be exciting to see what everyone accomplishes. I, along with Gitu, will be transitioning off as a junior mentor in December, too. I thank you all for the guidance and believing in me, because I'm beginning to be a member of the board as a Latin American and Caribbean representative. I truly can contribute to the Early Career Network for helping me achieve this leadership role and look forward to continue to support our network. I would like to invite you to the business meeting that is beginning in the auditorium at 9, so I hope to see you all there. Thank you.

ALI Career Workshop

Keiichi Fujiora

gynecologic cancer

mentorship

networking

ORADS 2022

PIPAC

adnexal masses

platinum-resistant ovarian cancer

gynae-oncology

IGCF