Gynaecological oncology research

Every day in Australia 18 women are diagnosed with a gynaecological cancer. In Australia, more than 6,500 women a year are diagnosed with a gynaecological malignancy including ovarian, endometrial, cervical and vulval cancers.

Our research aims to improve the outcomes and quality of life for these women and focuses on patient-reported outcomes and the supportive care of patients affected by these cancers. We also conduct research in gynaecological cancer genetics, the epidemiology of gynaecological malignancies, and biomarkers to predict relapse in women with high-grade serous ovarian cancer, the most common type of ovarian cancer. We are a recruiting site for clinical trials in gynaecological cancer and lead national and international multicentre randomised trials.

Getting the MOST out of follow-up: a randomised controlled trial to compare three-monthly nurse-led telephone follow-up, including monitoring serum CA125 and patient reported outcomes using the MOST (Measure of Ovarian Symptoms and Treatment concerns) with routine clinic-based follow-up, following completion of first-line chemotherapy in patients with epithelial ovarian cancer.

We were awarded competitive funding - a total of $370,000 - to lead a national phase II trial that will investigate the feasibility of a novel approach to the follow-up of women with ovarian cancer after completion of surgery and chemotherapy. Patients will have nurse led follow-up with three-monthly telephone calls and will complete a patient-reported symptom assessment called the Measure of Ovarian Symptoms and Treatment concerns (MOST) questionnaire and also have a blood test for the ovarian cancer tumour marker CA125 to diagnose ovarian cancer recurrence. Many patients, particularly those living in rural and remote locations may find it difficult and costly to travel to their hospital clinic appointments. We will assess the health-related quality of life of women undergoing this novel type of follow-up compared to conventional hospital clinic-based follow-up that includes completion of the MOST.

This study will also inform the design of a larger phase III randomised controlled trial. Secondary aims of both the pilot and subsequent phase III trials include comparing nurse-led telephone follow-up with conventional clinic-based follow-up and whether the nurse-led follow-up method is more cost-effective than the conventional model. St John of God Subiaco Hospital is the sponsor for this study. The study opened for recruitment in Perth in February 2021.

EXCISE Trial

The EXCISE Trial was an investigator-initiated, international, multicentre, open-label, parallel-group, phase II, randomised study. St John of God Subiaco Hospital was the lead site and sponsor for this study. Patients were enrolled at seven hospitals in Australia and New Zealand. We randomly assigned women aged 18 to 45 years with screen detected precancerous cervical cells (adenocarcinoma in situ) to one of two commonly used treatments - loop electrosurgical excision procedure (LEEP) or cold knife cone biopsy (CKC). 40 patients were randomly assigned 2:1 to LEEP or CKC. Patients in the CKC group had more post-operative complications (64.3% compared to 15.4% for LEEP). The results of the EXCISE Trial were published in the journal Gynecologic Oncology in December 2020.

• Professor Paul Cohen
• Sanela Bilic
• Maria Beilin
• Issy Black

Denisenko, E., de Kock, L., Tan, A., Beasley, A. B., Beilin, M., Jones, M. E., Hou, R., Muirí, D. Ó., Bilic, S., Mohan, G. R. K. A., Salfinger, S., Fox, S., Hmon, K. P. W., Yeow, Y., Kim, Y., John, R., Gilderman, T. S., Killingbeck, E., Gray, E. S., ... Forrest, A. R. R. Spatial transcriptomics reveals discrete tumour microenvironments and autocrine loops within ovarian cancer subclones. Nature Communications 2024, 15(1), Article 2860. Advance online publication. https://doi.org/10.1038/s41467-024-47271-y

Cohen, P. A single arm pilot observational study to evaluate the safety and feasibility of a pre-operative very low calorie diet in severely obese patients with endometrial cancer. International Journal of Gynecological Cancer 2024, 34(A150-A151). Advance online publication.

Hardcastle, S. J., Maxwell-Smith, C., Cavalheri, V., Boyle, T., Román, M. L., Platell, C., Levitt, M., Saunders, C., Sardelic, F., Nightingale, S., McCormick, J., Lynch, C., Cohen, P. A., Bulsara, M., & Hince, D. The promoting physical activity in regional and remote cancer survivors (PPARCS) trial: Physical activity maintenance. Scandinavian Journal of Medicine & Science in Sports 2024, 34(3), e14572. Article e14572. https://doi.org/10.1111/sms.14572

Kelly, S. M., Quenby, M., Corcoran, T. B., Webb, S., & Cohen, P. A. Variation in prescribing for the prevention of postoperative nausea, vomiting, and pain following abdominal surgery: A retrospective study. Health Science Reports 2024, 6(6), Article e1335. https://doi.org/10.1002/hsr2.1335

Schofield, C., Lopez, P., Cohen, P. A., Taaffe, D. R., Newton, R. U., Galvão, D. A., Jeffery, E., Meniawy, T. M., & Peddle-McIntyre, C. J. Skeletal muscle morphology in patients receiving primary versus interval cytoreductive surgery for advanced high-grade serous ovarian cancer. International Journal of Gynecological Cancer 2023, 33(10), 1587-1594. Article ijgc-2023-004425. https://doi.org/10.1136/ijgc-2023-004425

Cabasag, C. J., Arnold, M., Rutherford, M., Ferlay, J., Bardot, A., Morgan, E., Butler, J., O'Connell, D. L., Nelson, G., Høgdall, C., Schnack, T., Gavin, A., Elwood, M., Hanna, L., Gourley, C., De, P., Saint-Jacques, N., Mørch, L. S., Woods, R. R., ... Soerjomataram, I. Shifting incidence and survival of epithelial ovarian cancer (1995-2014): a SurvMark-2 study. International Journal of Cancer 2023, 152(9), 1763-1777. https://doi.org/10.1002/ijc.34403

kConFab Investigators, & NBCS Collaborators. FANCM missense variants and breast cancer risk: a casecontrol association study of 75,156 European women. European Journal of Human Genetics 2023, 31(5), 578- 587. https://doi.org/10.1038/s41431-022-01257-w

Schofield, C., Newton, R. U., Taaffe, D. R., Galvão, D. A., Cohen, P. A., Meniawy, T. M., & Peddle-McIntyre, C. J. Supervised resistance exercise for women with ovarian cancer who have completed first-line treatment: a pragmatic study. Supportive Care in Cancer 2023, 31(5), 304. Article 304. https://doi.org/10.1007/s00520-023-07754-y

NBCS Collaborators. The impact of coding germline variants on contralateral breast cancer risk and survival. American Journal of Human Genetics 2023, 110(3), 475-486. https://doi.org/10.1016/j.ajhg.2023.02.003

AOCS Group, Kang, E.-Y., Weir, A., Meagher, N. S., Farrington, K., Nelson, G. S., Ghatage, P., Lee, C.-H., Riggan, M. J., Bolithon, A., Popovic, G., Leung, B., Tang, K., Lambie, N., Millstein, J., Alsop, J., Anglesio, M. S., Ataseven, B., Barlow, E., ... Köbel, M. CCNE1 and survival of patients with tubo-ovarian high-grade serous carcinoma: An Ovarian Tumor Tissue Analysis consortium study. Cancer 2023, 129(5), 697-713. https://doi.org/10.1002/cncr.34582

Hardcastle, S. J., Maxwell-Smith, C., Cavalheri, V., Boyle, T., Román, M. L., Platell, C., Levitt, M., Saunders, C., Sardelic, F., Nightingale, S., McCormick, J., Lynch, C., Cohen, P. A., Bulsara, M., & Hince, D. A randomized controlled trial of Promoting Physical Activity in Regional and Remote Cancer Survivors (PPARCS). Journal of Sport and Health Science 2024, 13(1), 81-89. https://doi.org/10.1016/j.jshs.2023.01.003

Ovarian Tumor Tissue Analysis (OTTA) Consortium, Meagher, N. S., Gorringe, K. L., Wakefield, M. J., Bolithon, A., Pang, C. N. I., Chiu, D. S., Anglesio, M. S., Mallitt, K.-A., Doherty, J. A., Harris, H. R., Schildkraut, J. M., Berchuck, A., Cushing-Haugen, K. L., Chezar, K., Chou, A., Tan, A., Alsop, J., Barlow, E., ... Friedlander, M. L. Gene expression profiling of mucinous ovarian tumors and comparison with upper and lower gastrointestinal tumors identifies markers associated with adverse outcomes. Clinical cancer research : an official journal of the American Association for Cancer Research 2022, 28(24), 5383-5395. https://doi.org/10.1158/1078-0432.CCR-22-1206

Perera, S., Sporik, A., Schofield, P., Cohen, P., Hyde, S., Hegarty, S., Russell, H., Heriot, N., & Zalcberg, J. Patient-determined appropriateness of the EORTC QLQ-C30 and QLQ-OV28 for routine PROMs data collection in the National Gynae-Oncology Registry (NGOR): A thematic analysis of the perspectives and content needs of women with ovarian cancer. Asia-Pacific Journal of Clinical Oncology 2022, 18, 222-223. 

Boban, S. A., Bulsara, C., Codde, J., Cohen, P. A., & Downs, J. Employing cognitive interviewing to evaluate, improve and validate items for measuring the health-related quality of life of women diagnosed with ovarian cancer. BMC Women's Health 2022 , 22(1), Article 391. https://doi.org/10.1186/s12905-022-01966-w

Delahunty, R., Craig, S., Creighton, B., Ariyaratne, D., Garsed, D. W., Christie, E., Fereday, S., Andrews, L., Lewis, A., Limb, S., Pandey, A., Hendley, J., Traficante, N., Carvajal, N., Spurdle, A. B., Thompson, B., Parsons, M. T., Beshay, V., Volcheck, M., ... Alsop, K. TRACEBACK: Testing of Historical Tubo-Ovarian Cancer Patients for Hereditary Risk Genes as a Cancer Prevention Strategy in Family Members: Journal of Clinical Oncology. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2022, 40(18), 2036- 2047. https://doi.org/10.1200/JCO.21.02108

Powell, A., Hodgson, A., Cohen, P., Rabban, J. T., Park, K. J., Glenn McCluggage, W., Gilks, C. B., Singh, N., & Oliva, E. Improved risk prediction in HPV-associated endocervical adenocarcinoma through assessment of binary silva pattern-based classification: international multicenter retrospective study of the international society of gynecological pathologists. International Journal of Gynecological Cancer 2023, 33(Suppl 4). research-repository.uwa.edu.au

Denisenko, E., de Kock, L., Tan, A., Beasley, A. B., Beilin, M., Jones, M. E., Hou, R., Muirí, D. Ó., Bilic, S., Mohan, G. R. K. A., Salfinger, S., Fox, S., Hmon, K., Yeow, Y., Gray, E. S., Cohen, P. A., Yu, Y., & Forrest, A. R. R. Spatial transcriptomics reveals ovarian cancer subclones with distinct tumour microenvironments. bioRxiv 2022. https://doi.org/10.1101/2022.08.29.505206