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Molecular characterization of endometrial cancer is allowing for increased understanding of the natural history of tumors and paving a more solid pathway for novel therapies. It is becoming increasingly apparent that molecular classification is superior to histological classification in terms of reproducibility and prognostic discrimination. In particular, the Proactive Molecular Risk Classifier for Endometrial Cancer allows classification of endometrial cancer into groups very close to those determined by the Cancer Genome Atlas Research Network-that is, DNA polymerase epsilon-mutated, mismatch repair-deficient, p53 abnormal, and non-specific molecular profile tumors. The transition from the chemotherapy era to the age of targeted agents and immunotherapy, which started later in endometrial cancer than in many other tumor types, requires widespread availability of specialized pathology and access to novel agents. Likewise, surgical expertise and state-of-the-art radiotherapy modalities are required to ensure adequate care. Nevertheless, Latin American countries still face considerable barriers to implementation of international guidelines. As we witness the dawn of precision medicine as applied to endometrial cancer, we must make continued efforts towards improving the quality of care in this region. The current article discusses some of these challenges and possible solutions., Competing Interests: Competing interests: AB has received speaker fees from GSK. FMC has received speaker fees from GSK, AstraZeneca, Daiichi Sankyo, Roche, and MSD. AN-R has received speaker fees from Roche, MSD, AstraZeneca, Eisai, Daiichi Sankyo, Novartis, Pfizer, and Eli Lilly, and travel grants from Roche, MSD, AstraZeneca, Eisai, and Daiichi Sankyo. GG has received honoraria for conferences, advisory boards, and travel expenses from AstraZeneca, GSK, Roche, MSD, Raffo, Pink Pharma, and Bayer. MRM has received fees from Allarity Therapeutics, AstraZeneca, BIOCAD, BioNTech, Boehringer Ingelheim, Clovis, Daiichi Sankyo, Eisai, Genmab, GSK, Immunogen, Karyopharm, Merck, Mersana, Novartis, Regeneron, Roche, Seagen, Takeda, and Zaila, and is a member of the board of directors, and hold shares at Karyopharm and Sera Prognostics., (© IGCS and ESGO 2024. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.)

Competing Interests: Disclosure AO has served on advisory boards for AstraZeneca Farmaceutica Spain, SA, AstraZeneca KK, Clovis Oncology, Corcept Therapeutics, Deciphera Pharmaceutical, Eisai Europe Limited, EMD Serono, Inc., Roche, GlaxoSmithKline (GSK), Got It Consulting SL, Immunogen, Merck Sharp & Dohme (MSD) de España, Mersana Therapeutics, Novocure GmbH, PharmaMar, prIME Oncology, Roche, Shattuck Labs, Inc., Sutro Biopharma, Agenus and Tesaro and received support for travel or accommodation from Roche, AstraZeneca and PharmaMar, research funding paid directly to institution from AbbVie Deutschland, Ability Pharma, Advaxis Inc., Aeterna Zentaris, Amgen SA, Aprea Therapeutics AB, Clovis Oncology, Eisai, F. Hoffmann-La Roche, Regeneron Pharmaceuticals, ImmunoGen, MSD de España SA, Millennium Pharmaceuticals, PharmaMar SA, Tesaro and Bristol Myers Squibb (BMS), participation to non-remunerated activities and non-remunerated leadership roles for GCIC and GEICO; TJB has received an invited speaker fee from GSK; CLC reports Varian research grant to institution for research on proton therapy for cervix cancers, Elekta research funding for planning platform to institution for brachytherapy research and honoraria compensation to institution for time spent on independent data monitoring committee from Merck; GG reports honoraria from AstraZeneca, MSD, GSK, Laboratorios Raffo, Pint Pharma, Janssen Cilag as speaker, consultant advisory board member and writer for MSD; PH reports personal fees and institutional research grants from AstraZeneca, Roche, GSK and ImmunoGen, institutional research support from Genmab, personal fees on advisory boards for MSD and Clovis, invited speaker fees for Amgen, Stryker and Zai Lab, personal fees from SOTIO, grants from Public funding (European Union, DKH, DFG), Boehringer Ingelheim and Medac; FJ reports honoraria for advisory boards from GSK, AstraZeneca, MSD, Janssen, Ipsen, BMS and Bayer, speaker fees from GSK, AstraZeneca, Janssen, Ipsen, Amgen, Sanofi, Clovis and Astellas and institutional funding for work in clinical trials from GSK and AstraZeneca and a research grant from BMS; DL reports consultant honoraria from AstraZeneca, Clovis Oncology, GSK, MSD, ImmunoGen, Genmab, Amgen, Seagen and PharmaMar, invited speaker and member of advisory boards from AstraZeneca, invited member of advisory board from Merck Serono, invited speaker and member of advisory boards and receives direct research funding from Clovis Oncology, GSK, MSD and PharmaMar, institutional funding for work in clinical trials/contracted research from AstraZeneca, Clovis Oncology, GSK, MSD, Genmab, Seagen, ImmunoGen, Incyte, Novartis and Roche and participates in non-remunerated activities as principal investigator and non-remunerated leadership roles for GCIC; CM reports honoraria for advisory boards from Roche, Novartis, Amgen, MSD/Merck, PharmaMar, Seagen, AstraZeneca, Eisai and GSK and non-remunerated leadership roles for AGO-Austria, European Network for Gynaecological Oncological Trial groups and ABGSC; VM reports institutional research study support from MSD/Merck, Eisai, Clovis, Karyopharm, AstraZeneca and Zymeworks and non-remunerated activities for MSD/Merck, Eisai, Clovis, Novartis, Lilly, GSK, Karyopharm, Faeth, iTeos, Genentech, Mereo and Takeda and is supported in part by the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748; MRM reports advisory board participation and honoraria from AstraZeneca, BIOCAD, GSK, Karyopharm, Merck, Roche and Zai Lab, speaker honoraria from AstraZeneca and GSK, stocks/shares and member of board of directors from Karyopharm, institutional research grants from Apexigen, AstraZeneca, GSK, Ultimovacs and Deciphera and trial chair for Deciphera; JAL has received honoraria for lectures and advisory boards from AstraZeneca, Tesaro Bio/GSK and Eisai; honoraria for lectures from Clovis Oncology and Neopharm; for advisory boards from Artios Pharma, MSD/Merck, BMS, VBL Therapeutics and Nuvation, compensation from Regeneron and institutional research grants from AstraZeneca MSD/Merck, non-remunerated work in clinical trials for MSD, Clovis Oncology, Pfizer, GSK/Tesaro Bio and AstraZeneca and is past vice President for the European Society of Gynaecological Oncology; NC has received honoraria for lectures from AstraZeneca, Tesaro and Novartis, honoraria for advisory board from Roche, PharmaMar, AstraZeneca, MSD, Merck, Clovis Oncology, Tesaro, GSK, Pfizer, Takeda, BIOCAD, ImmunoGen, Mersana and Eisai and has received research grant from AstraZeneca, PharmaMar and Roche.

The incidence and mortality rates of ovarian cancer are increasing globally. Ovarian cancer is diagnosed at an advanced stage in 80% of women. After standard, platinum-based, front-line chemotherapy, poly (ADP-ribose) polymerase (PARP) inhibitors and antiangiogenic agents are successfully employed as maintenance strategies for newly diagnosed, advanced ovarian cancer patients. Landmark clinical studies, including SOLO-1, PAOLA-1, PRIMA, and VELIA, have provided crucial insights on optimizing first-line maintenance treatment using PARP inhibitors. A group of ovarian cancer experts, primarily from low- and middle-income countries, met in September 2019 to discuss new developments for the first-line treatment of ovarian cancer and its implications. Key implications of the evolving clinical data included: (1) olaparib or niraparib maintenance therapy appears to be the preferred choice for patients with BRCA 1/2 mutations; hence, BRCA testing is beneficial in identifying these patients; (2) niraparib monotherapy and olaparib in combination with bevacizumab have demonstrated significant benefit in progression-free survival (PFS) in homologous recombination deficiency (HRD)-positive patients; (3) bevacizumab, niraparib alone, or observation can be an alternative for HRD-negative patients; (4) further data is warranted to explore the role of PARP inhibitors in treating HRD-negative, ovarian cancer patients to confirm findings of the exploratory analysis of PRIMA; (5) PARP inhibitors may be beneficial for stage IV ovarian cancer patients with inoperable disease and patients with prior neoadjuvant chemotherapy; and (6) there is an urgent need to increase awareness in both clinicians and patients on BRCA and HRD testing for optimizing treatment decision-making and improving clinical outcomes in newly diagnosed, advanced ovarian cancer patients. In clinical medicine, the limited availability of family history (FH) information and the complexity of FH criteria has hampered the implementation of BRCA testing. Moreover, many cancer patients with BRCA mutations are not tested because they do not meet the criteria for FH. Consequently, BRCA testing in many high income countries, including the US and Australia, is underused and used inappropriately, which has resulted in the loss of valuable opportunities for better cancer management and cancer prevention., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jeffrey C.H. Goh – has been Advisory Board member, received sponsorship for conference and speaker’s bureau from AstraZeneca and Advisory Board Member for Tesaro. Charlie Gourley- has been part of advisory boards of Roche, Astrazeneca, MSD, Tesaro, Nucana, Clovis Foundation One, Sierra and has received research funding for Astrazeneca, Novartis, Aprea, Nucana and Tesaro. David SP Tan- has received research support from Astra Zeneca, Karyopharm Therapeutics, Bayer, Roche. Has been a part of Advisory Boards for Astra Zeneca, Roche, Bayer, MSD, Eisai, and Tessa Therapeutics and received honoraria from Astra Zeneca, Novartis, Roche, MSD, Bayer, Eisai, Takeda and Eisai. Angelica Nogueira-Rodrigues has been consultant for Eurofarma, Roche, Astra Zeneca, MSD, GSK and Eisai and received educational training from Roche, Eurofarma, Astra Zeneca, MSD. Hesham Elghazaly- No conflicts of interest. Marc Edy Pierre- No conflicts of interest. Gonzalo Giornelli- has been part of Adboard for AstraZeneca, Roche, MSD, Janssen Cilag and Speaker for AstraZeneca, MSD. Byoung-Gie Kim- No conflicts of interest. Flavia Morales – Vasquez- No conflicts of interest. Alexandra Tyulyandina- has received research support from Astra Zeneca, Roche, MSD and received honoraria from Astra Zeneca, Roche, MSD, Biocad, Tekeda, Pfiser, Eisai., (© 2022 The Authors.)

Aim:  FLABRA evaluated the prevalence of BRCA mutations, genetic counseling and management approaches in patients with ovarian cancer in Latin America. Patients & methods: Patients with ovarian cancer from six Latin-American countries were enrolled. Tumor samples were tested for BRCA mutations ( BRCA mut ). In cases with BRCA mut , blood samples were analyzed to determine germline versus somatic mutations. Medical records were reviewed for counseling approach and treatment plan. Results: From 472 patients enrolled, 406 samples yielded conclusive results: 282 were BRCA wild-type ( BRCA wt ), 115 were  BRCA mut  and nine were variants of uncertain significance. In total, 110/115 were tested for germline mutations (77 germline and 33 somatic). Conclusion: Tumor testing to identify mutations in BRCA1/2  in ovarian cancer can help optimize treatment choices, meaning fewer patients require germline testing and genetic counseling, a scant resource in Latin America. Clinical trial registration: NCT02984423 (ClinicalTrials.gov).