The role of molecular tests for adjuvant and post-surgical treatment in gynaecological cancers

• Published in: Best practice & research. Clinical obstetrics & gynaecology 2022-01, Vol.78, p.14-35
• Main Authors: Wijaya, Silvana Talisa, Ngoi, Natalie YL, Tan, David SP
• Format: Article
• Language: English
• Subjects: Biomarkers; Cancer therapy; Carcinoma, Ovarian Epithelial; Endometrial Neoplasms - genetics; Endometrial Neoplasms - surgery; Female; Genital Neoplasms, Female - genetics; Genital Neoplasms, Female - surgery; Gynaecological cancers; Humans; Molecular assays; Neoplasm Recurrence, Local; Ovarian Neoplasms - genetics; Ovarian Neoplasms - surgery; Uterine Cervical Neoplasms
• ISSN: 1521-6934; 1532-1932
• DOI: 10.1016/j.bpobgyn.2021.06.003

The adjuvant and post-surgical treatment of gynaecological cancers has historically been guided by the estimation of relapse risk based on clinicopathological factors determined at the time of cancer diagnosis. The recent advancement of genomic and molecular characterisation of gynaecological cancers has begun to shift paradigms in the selection of adjuvant treatment strategy. Recent data regarding the predictive and/or prognostic value of molecular tests in the treatment of advanced ovarian cancer as well as early stage endometrial cancer have been the first such examples to enter adjuvant treatment guidelines for these diseases. In this article, we discuss the current state and future development of molecular assays for gynaecological cancers and how they impact upon treatment selection for ovarian, endometrial and cervical cancers in the post-surgical setting. •Molecular biomarkers have an increasing role in the selection of adjuvant treatment.•Homologous recombination deficiency (HRD) predicts benefit from maintenance poly(ADP)-ribose polymerase inhibitor (PARPi) in advanced ovarian cancer.•Endometrial cancer (EC) molecular subgroups have prognostic and predictive significance. Trials are ongoing to validate the role of molecular biomarkers prospectively.•POLE-mutant ECs have an excellent prognosis and may not benefit from adjuvant therapy.•p53-mutant ECs derive the most benefit from the addition of chemotherapy to radiation therapy.