Search

Limited evidence exists on the impact of spatial and temporal heterogeneity of high-grade serous ovarian cancer (HGSOC) on tumour evolution, clinical outcomes and surgical operability. We perform systematic multi-site tumour mapping at presentation and matched relapse from 49 high tumour burden patients, operated upfront. From SNP array-derived copy number data, we categorise dendrograms representing tumour clonal evolution as sympodial or dichotomous, noting most chemo-resistant patients favour simpler sympodial evolution. Three distinct tumour evolutionary patterns from primary to relapse are identified, demonstrating recurrent disease may emerge from pre-existing or newly detected clones. Crucially, we identify spatial heterogeneity for clinically actionable homologous recombination deficiency scores, and for poor prognosis biomarkers CCNE1 and MYC. Copy-number signature, phenotypic, proteomic and proliferative-index heterogeneity further highlights HGSOC complexity. This study explores HGSOC evolution and dissemination across space and time, its impact on optimal surgical cytoreductive effort and clinical outcomes, and consequences for clinical decision-making.

Background: Standard of care first line chemotherapy for epithelial ovarian cancer (EOC) is carboplatin and paclitaxel administered once every three weeks. The JGOG3016 trial reported significant improvement in progression-free (PFS) and overall survival (OS) with dose-dense weekly paclitaxel and three-weekly carboplatin. However, this benefit was not observed in the progression free survival results of ICON8, previously reported. Here, we present the final co-primary OS and updated PFS outcomes. Methods: Women aged 18 or above with newly diagnosed International Federation of Gynecology and Obstetrics (FIGO) stage IC-IV EOC were recruited. Patients were randomly assigned to one of three groups; group 1: 3-weekly carboplatin area under the curve (AUC) 5/6 and 3-weekly paclitaxel 175mg/m2, group 2: 3-weekly carboplatin AUC5/6 and weekly paclitaxel 80mg/m2, group 3: weekly carboplatin AUC2 and weekly paclitaxel 80mg/m2, all administered by intravenous infusion. Patients entered the trial after immediate primary surgery (IPS) or received delayed primary surgery (DPS) during chemotherapy. Randomisation was performed using minimisation with stratification factors of GCIG group, disease stage and outcome and timing of surgery. Co-primary outcomes were PFS and OS, with comparisons performed between group 2 and group 1, and group 3 and group 1. Intention-to-treat analyses were powered to detect a hazard ratio of 0.75 in favour of the experimental groups. The trial is registered on clinicaltrials.gov as NCT01654146 and controlled-trials.com asISRCTN10356387. Findings: Between 6 Jun 2011 and 28 Nov 2014, 1566 women were recruited; group 1 (N=522), group 2 (N=523) and group 3 (N=521). Baseline characteristics include median age 62, 69% high grade serous carcinoma, 72% stage IIIC-IV disease, 48% IPS. By March 2020, with a median follow up of 69 months (IQR 61-75 months), 324, 309 and 313 deaths had occurred in groups 1, 2 and 3 respectively. No significant difference in OS was observed in either comparison: HR 0.87 (97.5% CI 0.73, 1.05) group 2 vs group 1, HR 0.91 (97.5% CI 0.76, 1.09) group 3 vs group 1. Most common G3/4 adverse events were reduced neutrophils (78, 183, 154 in groups 1, 2, 3) reduced white blood cell count (22, 80, 71 In groups 1, 2, 3) and anaemia (26, 66, 25 in groups 1, 2, 3). No new serious adverse events were reported. Interpretation: First-line weekly dose-dense chemotherapy does not improve OS for patients with EOC compared with standard 3-weekly chemotherapy and should not be used as part of standard multimodality ovarian cancer treatment for Caucasian women in the front-line setting. Funding: Cancer Research UK, Medical Research Council, Health Research Board in Ireland, Irish Cancer Society, Cancer Australia.

The Gynecologic Cancer InterGroup (GCIG) sixth Ovarian Cancer Conference on Clinical Research (OCCC6) was held virtually in October 2021 following published consensus guidelines. All 33 GCIG member groups participated in the development, refinement, and adoption of 20 statements within 4 topic groups on clinical research including first line treatment, recurrent disease, disease subgroups and future trials. Unanimous consensus was obtained for 14 of 20 statements, with >90% concordance in the remaining 6 statements. The high acceptance rate following active deliberation amongst the GCIG groups confirmed that a consensus process could be applied in a virtual setting. Together with detailed categorisation of unmet needs, these consensus statements will promote harmonisation of international clinical research in ovarian cancer.

BackgroundPlatinum-based neoadjuvant chemotherapy (NACT) followed by delayed primary surgery (DPS) is an established strategy for women with newly diagnosed, advanced stage epithelial ovarian cancer. Although this therapeutic approach has been validated in randomised, phase III trials,evaluation of response to NACT using Response Evaluation Criteria in Solid Tumours (RECIST)and CA125 was not reported. We describeRECIST and Gynecologic Cancer InterGroup (GCIG)CA125 responses in patients receiving platinum-based NACT followed by DPS in the phase III trial, ICON8.MethodsICON8 was an international, multicentre, randomised, phase III trial in which women ≥18 years old with an Eastern Cooperative Oncology Group performance status of 0-2, life expectancy >12 weeks and newly diagnosed International Federation of Gynecology and Obstetrics (FIGO;1988) stage IC-IIA high-grade serous, clear cell or any poorly differentiated/grade 3 histological subtype or any FIGO (1988) stage IIB-IV epithelial cancer of the ovary, fallopian tube or primary peritoneum were randomised (1:1:1) to receive either intravenous (IV) carboplatin (AUC5/6)and IV paclitaxel (175mg/m2by body surface area [BSA])on day 1 of every 21-day cycle(control arm)or IV carboplatin (AUC5/6)on day 1 and IV paclitaxel (80mg/m2by BSA)on days 1, 8 and 15 of every 21-day cycle(dose-fractionated paclitaxelarm) or IV carboplatin (AUC2)and IV paclitaxel (80mg/m2by BSA)on days 1, 8 and 15 of every 21-day cycle(dose-fractionated carboplatin and paclitaxelarm). Randomisation occurred using a minimisation method and patients where stratified according to GCIG group, disease stage and timing and outcome of cytoreductive surgery. Neither patients nor clinicians were masked to their allocated group. The scheduling of surgery and use of NACTwere determined by local multidisciplinary case review. In this post-hoc 5exploratory analysis of ICON8, progression-free survival (PFS) was analysed using the landmark method and defined as the time interval between the date of pre-surgical planning radiological tumour assessment to the date of investigator-assessed clinical or radiological progression or death, whichever occurred first. This is different to the intention-to-treat primary PFS efficacy analysis of ICON8, which definedPFS as the time from randomisation to the date of clinical or radiological progression or death, whichever occurred first. This post-hoc exploratory analysis includes only women recruited to ICON8thatwere planned for NACT followed by DPS and had RECIST v1.1 and/or GCIG CA125 evaluable disease. ICON8isclosed for enrolment and follow-up, and registered with ClinicalTrials.gov, number: NCT01654146. Findings: BetweenJune 6,2011 and November 28,2014,1,566 women were enrolled in ICON8.Seven hundred and seventy-nine women were planned forNACT followed by DPS(NACT-DPS). In the NACT-DPS population,94% had FIGO stage IIIC/IV disease. Five hundred and sixty-four women had RECIST evaluable disease at trial entry and the complete or partial response rate (CR/PR) was 62%(348/564). Seven hundred and twenty-seven women were evaluable by GCIG CA125 criteria at the time of diagnosis and 84%(610/727) had a CA125 response. The median PFS was 14.4 months (95% CI [confidence interval] 9.2-28.0months; 297 events) for RECIST CR/PR and 13.3 months (95% CI 8.1-20.1months; 171 events) for RECIST stable disease(SD). The median PFS for those women with a GCIG CA125 response was 13.8 months (95% CI 8.8-23.4months; 544 events) and 9.7 months (95% CI 5.8-14.5months; 111 events) for those without. Complete cytoreduction(R0) was achieved in 56% (187/335) of women with RECISTCR/PRand42% (73/172) with RECIST SD. Complete cytoreduction (R0) was achieved in50% (290/576) and 30% (30/101) of women 6with and without a GCIG CA125 response, respectively. The median follow-up was 29.5 months (interquartile range:15.6-54.3months) for the NACT-DPS population.InterpretationThe RECIST-defined radiological response was lower than frequently quoted to patients in the clinic. RECIST v1.1 and GCIGCA125 responses to NACT for epithelial ovarian cancer should not be used as individual predictive markers to stratify patients likely to benefit from DPS, but instead used in conjunction with the patient’s clinical capacity to undergo cytoreductive surgery. A patient should not be denied surgery based solely on the lack of a RECIST v1.1 or GCIG CA125 response.

Background Carboplatin and paclitaxel administered every three weeks is standard-of-care first-line chemotherapy for epithelial ovarian cancer (EOC). The Japanese JGOG3016 trial demonstrated a significant improvement in progression-free (PFS) and overall survival (OS) with dose-dense weekly paclitaxel and three-weekly carboplatin. We compared efficacy and safety of two dose-dense weekly regimens to standard 3-weekly chemotherapy in a predominantly European EOC population. Methods In this phase 3 trial, women with newly diagnosed FIGO stage Ic-IV EOC were randomised 1:1:1 to Arm 1 (carboplatin (AUC5/6) and paclitaxel (175mg/m2) every 3 weeks), Arm 2 (carboplatin (AUC5/6) every 3 weeks and paclitaxel (80mg/m2) weekly) or Arm 3 (carboplatin (AUC2) and paclitaxel (80 mg/m2) weekly). Patients entered after immediate primary surgery, or prior to neo-adjuvant chemotherapy before planned delayed primary surgery. An intention-to-treat primary PFS efficacy analysis compared Arm 2 vs 1 and Arm 3 vs 1. Findings 1566 women were randomised. 72%, 60% and 63% completed 6 protocol-defined treatment cycles in Arms 1, 2 and 3 respectively, although 90%, 89% and 85% completed 6 platinum-based chemotherapy cycles. Paclitaxel dose-intensification was achieved with weekly treatment (median total paclitaxel dose 1011; 1234; 1274 mg/m2). Although Grade 3/4 toxicity increased with weekly treatment, this was predominantly uncomplicated. Febrile neutropenia and sensory neuropathy incidences were similar across arms. By February 2017, 64% patients had experienced disease progression. No significant PFS increase was observed with either weekly regimen (log-rank Arm 2vs1 p=0.3532; Arm 3vs1 p=0.5130, non-proportionality p=0.0297, restricted mean survival time = 24.4; 24.9; 25.3 months in Arms 1, 2, 3 with 97.5% CI: 23.0 to 26.0; 24.0 to 25.9; 23.9 to 26.9 months respectively). Interpretation Weekly dose-dense chemotherapy can be delivered successfully as first-line EOC treatment but does not significantly improve PFS compared to standard 3-weekly chemotherapy in predominantly European populations.

The European Society of Gynaecological Oncology, the European Society for Medical Oncology (ESMO) and the European Society of Pathology held a consensus conference (CC) on ovarian cancer on 15-16 June 2022 in Valencia, Spain. The CC panel included 44 experts in the management of ovarian cancer and pathology, an ESMO scientific advisor and a methodologist. The aim was to discuss new or contentious topics and develop recommendations to improve and harmonise the management of patients with ovarian cancer. Eighteen questions were identified for discussion under four main topics: (i) pathology and molecular biology, (ii) early-stage disease and pelvic mass in pregnancy, (iii) advanced stage (including older/frail patients) and (iv) recurrent disease. The panel was divided into four working groups (WGs) to each address questions relating to one of the four topics outlined above, based on their expertise. Relevant scientific literature was reviewed in advance. Recommendations were developed by the WGs and then presented to the entire panel for further discussion and amendment before voting. This manuscript focuses on the recommendation statements that reached a consensus, their voting results and a summary of evidence supporting each recommendation., Competing Interests: Disclosure JAL reports personal fees for advisory board membership from Artios Pharma, AstraZeneca, Bristol Myers Squibb (BMS), Clovis Oncology, Eisai, Ellipses, GSK, Immagene, ImmunoGen, Merck/MSD, Miltenyi, Novocure, Nuvation and VBL Therapeutics; personal fees as an invited speaker from AstraZeneca, Clovis Oncology, GSK and Neopharm; personal fees as an Independent Data Monitoring Committee (IDMC) member from Mersana and Sutro Bio; a remunerated leadership role as an Associate Editor of Therapeutic Advances in Medical Oncology (Sage Publishing); institutional research grants from AstraZeneca and MSD/Merck; non-remunerated roles at ESMO (Officer and Subject Editor for the Gynaecological CPGs); and a non-remunerated leadership role as Vice-President of ESGO (2019-2021). XMG reports personal fees for advisory board membership from Amgen, AstraZeneca, GSK, Janssen and Lilly; personal fees as an invited speaker from AstraZeneca, Clovis and GSK; and non-renumerated consultancy for AstraZeneca. FA reports personal fees for advisory board membership from MiMARK Diagnostics; and institutional funding from Estée Lauder. NCon reports personal fees for advisory board membership from AkesoBio, AstraZeneca, Eisai, eTheRNA Immunotherapies, GSK, ImmunoGen, Kartos, Mersana, Seagen and Seattle Genetics; personal fees as an invited speaker from Eickeler, Medconcept, Mediseminar, the Nordic Society Of Gynaecologic Oncology - Clinical Trial Unit (NSGO-CTU) and the North-Eastern German Society of Gynecological Oncology (NOGGO); travel compensation from Amgen, Genmab and Roche; compensation for educational activities from Kartos, Medscape Oncology, MSD and TouchIME; non-renumerated role as the Co-Chair of the Early Drug Development Network of European Network for Gynaecological Oncological Trial groups (ENGOT); non-renumerated role as the President of ESGO; and a non-renumerated role as a clinical trial principal investigator (PI) for Aldeyra, Clovis, Kartos, Mersana and Seagen. BD reports personal fees as an invited speaker from MSD. CFo reports personal fees as an invited speaker from Roche, AstraZeneca, MSD, Clovis, Sequana, GSK, Tesaro and Ethicon; and institutional fees as a member of the Board of Directors of the King Edward VII Hospital. AGM reports personal fees for advisory board membership from Alkermes, Amgen, AstraZeneca, Clovis Oncology, Eisai, Genmab, GSK, HederaDx, Illumina, ImmunoGen, MacroGenics, Mersana, MSD, Novartis, Oncoinvent, PharmaMar, Regeneron, Roche, SOTIO, Sutro Biopharma and Tubulis; personal fees as an invited speaker from AstraZeneca, Clovis Oncology, GSK, MSD, Novocure, Roche, Takeda and Zai Lab; institutional funding as coordinating PI from Aravive, GSK, Novartis and Roche; and non-remunerated membership of a Steering Committee for MSD. CG reports personal and institutional fees for advisory board membership from AstraZeneca, GlaxoSmithKline and MSD; personal and institutional fees as an invited speaker from AstraZeneca, Chugai, Clovis, Eisai, GSK, MSD, Roche and Takeda; personal fees for a writing engagement from Cor2Ed and PeerVoice; institutional research grants from Aprea, AstraZeneca, Medannex, Novartis and Nucana; institutional research grants as a local PI from BerGenBio, Clovis, GlaxoSmithKline, MSD, Roche and Verastem; and non-renumerated membership of the Cancer Research UK Clinical Research Committee, the German Cancer Aid Scientific Review Committee and the International Clinical Cancer Research Committee. AL reports personal fees for advisory board membership from Zentalis Pharmaceuticals; personal fees as an invited speaker from GSK and Medscape; personal fees for consultancy from GLG; personal fees for a writing engagement from Onko+; institutional fees for advisory board membership from Ability Pharma, Apmonia, AstraZeneca, Blueprint, Clovis Oncology, GSK, Merck Serono and MSD; institutional fees as an invited speaker from AstraZeneca, Clovis Oncology and Kephren Publishing; institutional fees for consultancy from Orion and Owkin; institutional fees for Steering Committee membership for MSD; institutional funding as a PI in clinical trials from Agenus, AstraZeneca, BMS, GSK, Iovance; MSD and Roche; institutional funding as a Chief Investigator in clinical trials from AstraZeneca and OSE Immunotherapeutics; institutional research grants as a PI in translational research from Association de Recherche sur les CAncers dont GYnécologiques (ARCAGY)-Groupe d'Investigateurs Nationaux pour les Etudes des Cancers de l'Ovaire (GINECO), AstraZeneca and Sanofi; a non-remunerated role as an IDMC member for Clovis Oncology, as an IDMC Chair for Pfizer (proprietary information) and as a member of the Gynecologic Cancer InterGroup (GCIG); and non-remunerated academic research projects for LXRepair and Owkin. DL reports personal fees for advisory board membership from AstraZeneca, Clovis Oncology, Corcept, Genmab, GSK, ImmunoGen, MSD, Oncoinvest, PharmaMar, Seagen and Sutro Biopharma; personal fees as an invited speaker from AstraZeneca, Clovis Oncology, Genmab, GSK, ImmunoGen, MSD, PharmaMar and Seagen; personal fees for consultancy from AstraZeneca, Clovis Oncology, Genmab, GSK, ImmunoGen, MSD, Novartis, PharmaMar and Seagen; travel grants from AstraZeneca, Clovis Oncology and GSK; institutional funding as coordinating PI from Clovis Oncology, Genmab and MSD; institutional funding for a clinical trial/contracted research from AstraZeneca, Clovis Oncology, Genmab, GSK, ImmunoGen, Incyte, MSD, Novartis, Roche and Seagen; institutional funding for founding an academic trial from Clovis Oncology, GSK, MSD and PharmaMar; a non-remunerated role as a PI in clinical trials for AstraZeneca, Clovis Oncology, Genmab, GSK, ImmunoGen, Incyte, MSD, Novartis, PharmaMar, Roche and Seagen; and a non-remunerated role as a member of the Board of Directors of GCIG. SB reports personal fees for advisory board membership from Amgen, AstraZeneca, Eisai, Epsilogen, GSK, ImmunoGen, Mersana, MSD, Novartis, Oncxerna, Regeneron, Roche, Seagen, Shattuck Labs and Verastem; personal fees as an invited speaker from Amgen, AstraZeneca, Clovis, GSK, Medscape, Novacure, Peerview, Pfizer, Research to Practice and Takeda; ownership of stocks/shares of PerciHealth; institutional research grants from AstraZeneca and GSK; a non-remunerated role as a PI for AstraZeneca (academic-sponsored ENGOT-GYN1/ATARI phase II international trial), GSK (academic-sponsored MONITOR-UK trial) and Verastem (ENGOTov60/GOG3052/RAMP201 phase II clinical trial - global lead); a non-renumerated leadership role as Board member of the International Cancer Foundation; and a non-renumerated advisory role as a medical advisor of Ovacome Charity. LC reports personal fees as an invited speaker from AstraZeneca and Corza Medical; and institutional fees as an invited speaker from GSK and Roche. DC reports personal fees for advisory board membership from Akesobio, GSK, MSD, Novocure, Roche, Seagen and SOTIO; and personal fees as an invited speaker from AstraZeneca. NCol reports personal fees for advisory board membership from AstraZeneca, Clovis Oncology, Eisai, GSK, ImmunoGen, Mersana, MSD/Merck, Nuvation Bio, Onxerna, Pfizer, PharmaMar, Pieris and Roche; personal fees as an invited speaker from AstraZeneca and Novartis; institutional research grants from AstraZeneca, PharmaMar and Roche; a non-renumerated membership of the ESMO Guidelines Steering Committee; and a non-renumerated leadership role as Chair of the Alleanza Contro il Tumore Ovarico (ACTO) Scientific Committee. SC declares no conflicts of interest. AGE reports personal fees for advisory board membership from AstraZeneca; personal fees as an invited speaker from GSK and Intuitive Surgical; personal fees as the social media editor of the International Journal of Gynecologic Cancer; and a non-remunerated role as PI of the SENTICOL III trial in Norway for GINECO/NSGO. CFa reports personal fees for advisory board membership from Baxter, Chugai Pharma, Clovis Oncology, Eisai, GSK and Teva; personal fees as an invited speaker from Astellas Pharma, AstraZeneca, Biogaran, BMS, GSK, Janssen Oncology, Leo Pharma, Lilly, MSD Oncology, Novartis, Pfizer Seagen and Viatris; institutional funding as coordinating PI from Astellas Pharma, Chugai Pharma, Pfizer and Pierre Fabre; institutional funding as local PI from Pfizer; non-renumerated congress participation for AstraZeneca, Janssen Oncology, Leo Pharma and Pierre Fabre; and non-renumerated membership of the European Union of Geriatric Medicine Society, the French Society of Geriatrics and Gerontology, the International Society of Geriatric Oncology and the French Society of Geriatric Oncology. DF declares no conflicts of interest. PH reports personal fees for advisory board membership from AstraZeneca, Clovis Oncology, GSK, ImmunoGen, Mersana, Miltenyi, MSD, Novartis and Roche; personal fees as an invited speaker from Amgen, Eisai, Stryker and Zai Lab; personal fees for lectures from AstraZeneca, GSK, MSD and Roche; personal fees as an IDMC member from SOTIO; institutional funding as Trial Chair from AstraZeneca, GSK, ImmunoGen and Roche; institutional funding as local PI from Genmab; institutional funding from Clovis Oncology and Seagen; and a non-remunerated role as PI for AstraZeneca. FJ reports personal fees for advisory board membership from AstraZeneca, Bayer, BMS, Eisai, GSK, Ipsen, Janssen, MSD, Novocure and Seagen; personal fees as an invited speaker from Amgen, Astellas, AstraZeneca, Eisai, GSK, Ipsen, Janssen, MSD and Novartis/3A; institutional funding as coordinating PI from AstraZeneca and GSK; an institutional research grant from BMS; non-renumerated membership of GCIG; and travel compensation from Eisai, GSK, Ipsen and MSD. CLa personal fees for advisory board membership from AstraZeneca and Illumina; and institutional funding from AstraZeneca. CLo declares no conflicts of interest. SM reports personal fees and reimbursement for advisory board membership from AbbVie, AstraZeneca, Clovis, Eisai and Novartis; personal fees and reimbursement as an invited speaker from GSK, Hubro, MSD, Nykode, Pfizer, Roche and Tesaro; and institutional research grants from AstraZeneca, Eisai, Roche and Tesaro. FM reports personal fees for advisory board membership from AstraZeneca, Eisai, GenomicHealth, Gilead/Immunomedics, MSD, Myriad, Novartis, PharmaMar, Roche and Seagen; personal fees as an invited speaker from AstraZeneca, Clovis, GSK/Tesaro, Lilly and Pfizer; institutional fees for advisory board membership from Immunicom and Roche; institutional fees as an invited speaker from AstraZeneca, Daiichi Sankyo, GSK and Seagen; institutional funding as coordinating PI from AGO Research GmbH, AstraZeneca, the German Breast Group, Gilead/Immunomedics and Roche; institutional funding as local PI from Eisai, GSK, MSD, Novartis, Roche and Vaccibody; and institutional funding from AstraZeneca, Lilly and Seagen. CM reports personal fees for advisory board membership from Amgen, AstraZeneca, GlaxoSmithKline, MSD, Novartis, PharmaMar, Roche Austria and Seagen; and personal fees as an invited speaker from Amgen, AstraZeneca, GlaxoSmithKline, MSD, Novartis, PharmaMar, Roche and Seagen. WGM reports personal fees as an invited speaker from GSK. IAM reports personal fees for advisory board membership from Alkermes, AstraZeneca, Clovis Oncology, Duke Street Bio, GSK, OncoC4, Roche and Theolytics; personal fees for consultancy from Duke Street Bio; personal fees for travel from AstraZeneca and GSK; institutional funding from AstraZeneca; and a non-remunerated role as a member of the Board of Directors (Trustee) of Worldwide Cancer Research. PM reports personal fees for advisory board membership from AstraZeneca, GSK and ImmunoGen. SN reports personal fees for advisory board membership from AstraZeneca and GSK; personal fees as an invited speaker from AstraZeneca, Clovis and GSK; personal fees for Scientific Committee membership from GSK; ownership of stocks/shares of GSK; and institutional funding from AstraZeneca. AO reports personal fees for advisory board membership from Agenus, AstraZeneca, Clovis Oncology, Corcept Therapeutics, Deciphera Pharmaceuticals, Eisai, Exelisis, EMD Serono, F. Hoffmann-La Roche, Genmab, GSK, ImmunoGen, Itheos, Merck Sharps & Dohme de España, SA, Mersana Therapeutics, Novocure, OneXerna Therapeutics, Inc., PharmaMar, Regeneron, Sattucklabs, Seagen and Sutro Biopharma; personal fees for travel/accommodation from AstraZeneca, PharmaMar and Roche; institutional funding from Abbvie Deutschland, Advaxis Inc., Aeterna Zentaris, Amgen, Aprea Therapeutics AB, BMS, Clovis Oncology Inc., Eisai Ltd., F. Hoffmann-La Roche Ltd., ImmunoGen Inc., Merck, Sharp & Dohme de España SA, Millennium Pharmaceuticals Inc., PharmaMar SA, Regeneron Pharmaceuticals and Tesaro Inc.; non-remunerated roles at ESMO (member, Officer, Co-Chair of the ESMO Gynaecological Cancers Congress 2023-2025, Chair of the Gynaecological Track ESMO 2019, Scientific Track Member Gynaecological Cancers ESMO 2018, ESMO 2020, ESMO 2022, member of the Gynaecological Cancers Faculty and Subject Editor for the Gynaecological CPGs); non-remunerated roles at GCIG [member and Cervix Cancer Chair on behalf of the Spanish Ovarian Cancer Research Group (GEICO)]; and memberships of the American Society of Clinical Oncology, the Gynecologic Oncology Group and the Spanish Association of Medical Oncology (SEOM). JAPF reports personal fees for advisory board membership from Abilify Pharma, AstraZeneca, Clovis, GSK, PharmaMar and Roche; personal fees as an invited speaker from AstraZeneca, Clovis, GSK and PharmaMar; employment as Associate Professor at the University of Valencia; institutional funding as coordinating PI from AstraZeneca; institutional funding from Novartis and GSK; institutional research grants from GSK and PharmaMar; personal fees as a member of a Steering Committee for Artios Pharma and AstraZeneca; a non-renumerated role as coordinating PI of a phase III trial for Novartis; non-renumerated membership of BIG, the Early Drug Development working group at ENGOT and the Adolescent and Young Adults working group at SEOM; a non-renumerated role as Co-chair of the Phase 2 group at GCIG; non-renumerated roles as member of the Executive Committee and Head of the Scientific Committee at GEICO; and non-renumerated roles as member of the Executive Committee and co-coordinator of Uterine Sarcoma Group at the Spanish Sarcoma Research Group. SP reports personal fees for advisory board membership from AstraZeneca, Clovis, GSK, MSD, PharmaMar and Roche; and institutional funding from AstraZeneca, MSD, Pfizer and Roche. PTR declares no conflicts of interest. IRC reports personal fees for advisory board membership from Adaptimmune, Agenus, Amgen, AstraZeneca, BMS, Clovis Oncology, Daiichi Sankyo, Deciphera, EQRX, Eisai, GSK, MacroGenics, Merck Sereno, Mersana, Novartis, Oxnea, Roche and Sutro Biopharma; institutional fees for advisory board membership from MSD; institutional fees for translational research from BMS; a non-remunerated role as President of GINECO; and a non-remunerated role as PI for PAOLA-1. IR reports personal fees for advisory board membership and as an invited speaker from AstraZeneca, Clovis, GSK, PharmaMar and Roche; institutional funding from AstraZeneca; an institutional research grant from GSK; a non-renumerated advisory role at GEICO; and non-renumerated membership of SEOM. GS reports personal fees as an invited speaker from AstraZeneca/MSD, Baxter Healthcare, GlaxoSmithKline, Intuitive Surgical Inc., Johnson & Johnson and Olympus Europa; personal fees for expert testimony from Covidien AG (a Medtronic company); institutional funding as coordinating PI from AstraZeneca, Bayer AG, Clovis Oncology, Kiromic, Merck, Novocure Ltd. and Oncoquest Pharmaceuticals Inc. JS reports personal fees for advisory board membership from AstraZeneca, GSK, Immunogene, Incyte, MSD, Novocure, Roche, Tesaro and Tubulis; personal fees as an invited speaker from Eisai; institutional funding from AstraZeneca, GSK and Roche; non-renumerated ENGOT/NOGGO proprietary information; non-renumerated leadership roles at AGO (Arbeitsgemeinschaft für Gynäkologische Onkologie), NOGGO and PARSGO (Pan-Arabian Research Society of Gynecological Oncology); and non-renumerated membership of the ESGO Council. RSF reports personal fees for advisory board membership from MSD and Neopharm; personal fees as an invited speaker from AstraZeneca, BMS, Medison, MSD, Novartis and Roche; personal fees for consultancy from Medison; personal fees as a member of a Steering Committee for MSD and VBL; non-renumerated membership of a Steering Committee for AstraZeneca; and an institutional research grant from MSD. SS reports personal fees as an invited speaker from AstraZeneca, GSK and MSD; an institutional research grant from AOA Dx; and a leadership role for the National Ovarian Cancer Audit (UK). DSPT reports personal fees for advisory board membership from AstraZeneca, Bayer, Boehringer Ingelheim, Eisai, Genmab, GSK, MSD and Roche; personal fees as an invited speaker from AstraZeneca, Eisai, GSK, Merck Serono, MSD, Roche and Takeda; ownership of stocks/shares of Asian Microbiome Library (AMiLi); institutional research grants from AstraZeneca, Bayer, Karyopharm Therapeutics and Roche; institutional funding as coordinating PI from AstraZeneca and Bergen Bio; institutional funding as local PI from Bayer, Byondis B.V. and Zeria Pharmaceutical Co Ltd.; a previous non-renumerated role as Chair of the Asia-Pacific Gynecologic Oncology Trials Group (APGOT); a previous non-renumerated role as the Society President of the Gynecologic Cancer Group Singapore; non-renumerated membership of the Board of Directors of the GCIG; and product samples from AstraZeneca, Cyclacel Pharmaceuticals, Eisai and MSD (non-financial interest). CT declares no conflicts of interest. WJvD declares no conflicts of interest. IV reports past personal fees for advisory board consultancy from Agenus, Aksebio China, AstraZeneca, BMS, Deciphera Pharmaceuticals, Eisai, F. Hoffmann-La Roche Ltd., Genmab, GSK, ImmunoGen Inc., Jazzpharma, Karyopharm, Molecular Partners, MSD, Novartis, Novocure, Oncoinvent AS, Regeneron, Seagen and SOTIO a.s.; past institutional fees for advisory board consultancy from Amgen (Europe), AstraZeneca, Carrick Therapeutics, Clovis Oncology Inc., Deciphera Pharmaceuticals, Elevar Therapeutics, F. Hoffmann-La Roche Ltd., Genmab, GSK, Mersana, Millennium Pharmaceuticals, MSD, Oncoinvent AS, SOTIO a.s., Verastem Oncology and Zentalis; and institutional research grants from Amgen, Genmab, Oncoinvent AS and Roche. FP declares no conflicts of interest. CS reports personal fees as a Gynaeco-oncology Certificate of Advanced Studies Coordinator for the European School of Oncology; personal fees as a DMC member from Merck; non-renumerated advisory roles for ESMO as a member of the Compliance Committee and an ESMO extended member of the Women for Oncology Committee; and a non-renumerated role as an advisor for the ESMO Living Guidelines. AF reports personal fees for advisory board membership from AstraZeneca and MSD; personal fees as an invited speaker from Fondazione Internazionale Menarini, GSK, Johnson & Johnson and PharmaMar; and institutional funding as coordinating PI from AstraZeneca, Johnson & Johnson and Roche., (Copyright © 2024 European Society for Medical Oncology, European Society of Gynecological Oncology, European Society of Pathology. Published by Elsevier Ltd.. All rights reserved.)