Gynecologic Cancer Program

INCIDENCE AND PREVALENCE

Ovarian cancer affects 1 in 78 women in the U.S. and is the fifth leading cause of cancer death among women. The incidence of uterine cancer is increasing around the world. It is estimated that 63,230 cases will be diagnosed in the United States in 2018. Though pre-cancerous changes of the cervix are diagnosed more often than invasive cervical cancer, an estimated 13,240 women will be diagnosed with invasive cervical cancer in 2018. Vaginal and vulvar cancers are rare, accounting for only 6-7% of all gynecologic cancers diagnosed in the United States.1

PROGRAM OVERVIEW

Hoag Family Cancer Institute, in collaboration with Hoag Women’s Health Institute, leads the way in gynecologic oncology in Orange County. Hoag’s Gynecologic Cancer Program’s expert team, patient volumes, and commitment to providing the highest quality care translate to outcomes that are consistently above national averages. The multidisciplinary team is comprised of fellowship-trained gynecologic oncologists, radiation oncologists, obstetriciangynecologists, pathologists, radiologists, and reconstructive surgeons who collaborate in the treatment of cervical, ovarian, uterine, vaginal and vulvar cancers.

Gynecologic Oncology Associates lead Hoag’s gynecologic oncology team of specialists.

DIAGNOSTICS

In 2017, the program implemented reflex tumor genomic profiling through Hoag Family Cancer Institute’s partnership with Caris Life Sciences for all patients with advanced gynecologic cancer. The comprehensive panel provides information about the unique molecular biology of each patient’s tumor including DNA, RNA, and protein expression identifying any actionable mutations, so physicians can apply a highly personalized treatment approach.

Hoag’s Radiology Department recently implemented the use of MRI for staging of uterine and cervical cancers. High resolution MRI imaging capability allows for better staging of parametrial invasion outside of the uterus and cervix over CT.

The program is also integrated with Hoag Interventional Radiology to perform biopsies and other procedures including thoracentesis and paracentesis to drain fluid off the lung and abdomen, respectively.

TREATMENT

Tumor Board

The multidisciplinary Gynecologic Cancer Tumor Board was launched in late 2017 and is attended by gynecologic oncologists, medical oncologists from the early phase clinical research program, radiation oncologists, obstetrician-gynecologists, pathologists, radiologists, plastic and reconstructive surgeons, geneticists, pelvic physical therapists and the clinical nurse navigator.

The Gynecologic Cancer Tumor Board meets the second Monday of every month at 7:30 a.m. at the Patty & George Hoag Cancer Center Newport Beach and via videoconferencing at Hoag Cancer Center Irvine. It is moderated by Alberto Mendivil, M.D.

To submit a case for the Gynecologic Cancer Tumor Board, contact the Gynecologic Cancer Nurse Navigator, Sandy Southerland, B.S.N., R.N., O.C.N., at 949-764-1804 or [email protected] or Rosana Figueroa at 949-764-7044 or [email protected]

Surgery

Robotic-assisted surgery is a cornerstone of the program. Hoag’s five gynecologic oncologists are highly trained and experienced in this technique and have received national recognition for their volumes and outcomes. Hoag maintains the third highest volume of gynecologic oncology robotic procedures in the nation. Recently, Hoag surpassed 10,000 total roboticassisted procedures, encompassing 10 surgical specialties. The Surgical Review Corporation named Hoag a Center of Excellence in Robotic Surgery (COERS), an honor recognizing health care institutions that consistently deliver the safest, highest-quality care in robotics. Intuitive Surgical selected Hoag as one of only two sites in the U.S. for their Executive Enrichment Program, which provides physicians and hospital administrators the opportunity to visit Hoag to learn about robotic surgery from our OR team, surgeons, and administrators.

Enhancing patient care and outcomes are continuous priorities. The gynecologic oncologists work collaboratively with plastic and reconstructive surgeons so that tumor removal and complex pelvic reconstruction can occur during the same surgery. The team also partnered with Hoag anesthesiologists and nurses to implement the Enhanced Recovery After Surgery (ERAS) protocol for gynecologic surgical patients with standardized interventions to decrease the amount of fluid the patient is given intraoperatively, minimize the use of narcotics, promote early ambulation and the frequent use of regional anesthesia. This program has resulted in shorter hospital stays and a better experience overall for patients.

A recent advancement in patient treatment involves the addition of sentinel lymph node mapping during surgery for cervical, uterus, and vulvar cancers employing the surgical robot and fluorescent imaging in the identification of the sentinel node to be removed. The state-of-the-art practice is proving to be an effective method for detecting nodal spread while reducing the incidence of lymphedema.

Chemotherapy

Heated Intraperitoneal Chemotherapy (HIPEC) is yet another innovative technique Hoag’s GYN oncologists use when clinically appropriate. Patients with recurrent ovarian, fallopian tube, or peritoneal cancer who meet certain criteria can benefit from HIPEC at the time of surgery as consolidation treatment. Hoag is one of a small number of centers in California that offers HIPEC for gynecologic cancers and is among an even smaller group that does HIPEC directly following robotic surgery, often allowing the patient to go home the next day.

Radiation Oncology

Hoag’s Radiation Oncology Department offers High Dose Rate Brachytherapy for internal radiation therapy of GYN cancers with the Elekta Flexitron HDR brachytherapy system. It is the latest HDR technology available. The department also provides standard external beam pelvis treatment modalities including Intensity-Modulated Radiation Therapy (IMRT).

CLINICAL RESEARCH

Clinical trials add to gynecologic cancer patients’ treatment options, including a newly opened vaccine trial for ovarian cancer currently only available at Hoag. The trial, appropriate for patients with stage 3 and 4 ovarian cancer, compares the use of treatment containing autologous dendritic cells recognizing individual tumor associated antigens (TAA) from autologous self-renewing tumor


cells vs. treatment containing non-stimulated autologous immune cells following completion of surgery and primary chemotherapy. Other early phase trials testing new agents are available to patients through Hoag Family Cancer Institute’s Developmental Therapeutics Program in alliance with USC Norris Comprehensive Cancer Center. The following clinical trials have opened at Hoag for patients with gynecologic cancers. For an up to date list of open trials, please contact Leila Andres, M.S., at 888-862-5318.


(149-17) Phase II, Double-Blind, Randomized Trial of AVOVA-1 (Autologous Dendritic Cells Loaded with Autologous Tumor Associated Antigens) vs. Autologous Peripheral Blood Mononuclear Cells (MC) in Patients with Stage II or IV Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Carcinoma after Primary Therapy (Phase II clinical trial, appropriate for patients with ovarian cancer)


(187-17) 0C-17-11: Phase I trial of ZW25 in patients with locally advanced (unresectable) and/or metastatic HER2- expressing cancers (Phase I clinical trial, appropriate for patients with HER2 expressing cancers.)


181-17/0C-14-2: An Open-Label, Phase 2 study of Neratinib in Patients with Solid Tumors with Somatic Human Epidermal Growth Factor Receptor (EGFR, HER2, HER3) Mutations or EGFR Gene Amplification


157-17/0C-18-2: A Phase I Study of FID-007 in Patients with Advanced Solid Tumors


(211-17) 0C-17-14: An Open-Label, Non-Randomized, Multicenter Study to Determine the Pharmacokinetics and Safety of Niraparib Following a Single Oral Dose in Patients with Advanced Solid Tumors and Either Normal Hepatic Function or Moderate Hepatic Impairment (Phase 1 Clinical trial appropriate for patients with advanced solid tumors)

SCREENING AND HIGH RISK SERVICES

Women with a strong family history of uterine or ovarian cancer are referred to Hoag’s Hereditary Cancer Program for genetic counseling and possible genetic testing. When testing reveals a germline mutation or inherited syndrome that increases a woman’s risk for ovarian cancer, Hoag’s High Risk Breast and Ovarian Cancer Prevention Program offers a comprehensive approach for medical management and risk reduction.

A multidisciplinary team of providers, which includes a gynecologic oncologist and breast surgical oncologist, radiologists, a registered dietitian, a licensed psychologist and certified sex therapist, a certified personal trainer, a yoga, meditation, and mindfulness coach, genetic counselors, and nurse navigator meets with each woman enrolled in the program. They develop a personalized plan comprised of screening and imaging, pelvic exams, and appropriate medical management, all of which is coordinated by the nurse navigator. Women who choose prophylactic surgery have the benefit of robotic-assisted surgery as well as advanced plastic and reconstructive surgery. The program also provides menopause management after surgery. Risk reducing surgery can impact many aspects of a woman’s life including intimacy and fertility and the team supports and guides women through these issues.

Patients at inherited risk for ovarian cancer are also often at risk for other cancers, and the program navigator helps link patients to other high risk cancer programs at Hoag Family Cancer Institute.

GYN oncologist Lisa Abaid, M.D., M.P.H., F.A.C.O.G., F.A.C.S., and breast surgical oncologist, Heather Macdonald, M.D., F.A.C.O.G., are co-medical directors of Hoag’s High Risk Breast and Ovarian Cancer Prevention Program.

EDUCATION AND SUPPORT Nurse Navigator, Sandy Southerland, B.S.N., R.N., O.C.N., offers personalized support, answers questions, addresses concerns, and coordinates care for gynecologic cancer patients. She also leads the monthly Gynecologic Cancer Support Group and connects patients to Hoag and community resources that can aid them in their cancer journey.

For patients who experience pelvic pain, incontinence, or other pelvic issues post-treatment, Hoag’s Pelvic Health Program offers pelvic floor physical therapy administered by physical therapists who have doctorates in physical therapy and focus on pelvic floor dysfunction. Services are available at Hoag Health Center Newport Beach as well as Hoag Health Center Irvine – Sand Canyon.

Gynecologic cancer patients also have access to Hoag Family Cancer Institute’s Integrated Cancer Support Services, Hoag’s Palliative Care Program, and a variety of wellness services in the Hoag for Her Center for Wellness.

1 American Cancer Society. Facts & Figures 2018. American Cancer Society. Atlanta, Ga. 2018.

For more information call: 949-722-6237