EGOS recommendations for ovarian cancer , Meeting the unmet needs

Basel Refky

Strength

• 110 million population .

​

• Number of cancer centers

​

• Geographical location.

​

• Oncology related HCP.

​

• Education , CME

​

• Widely accepted and applied MDT concepts .

Weakness

• 110 million population .

​

• Specialized teams , MDTs?

​

• Lack of national educational program or fellowship. ?? Ovarian surgery.

Opportunities

• Most ovarian cancer cases are refereed to cancer centers ( not like endometrial )

​

• EGOS.

​

• Clinical trials for emerging drugs .

​

• Governmental well .

​

• ESGO accredited training programs in ESGO accredited centers .

​

• Regional, international networks ( MEMAGO, PARSGO, ESGO,IGCS, ….)

Threats

• Financial crisis .

​

• Doctors leak.

​

• Conflicts of specialties ( Surgical oncology/gyn).

Ovarian cancer patient journey :

Diagnosis

Surgery

Systemic treatment

Surveillance

Financial toxicity

Psychological , sexual support

Palliative care & End of life care

PARPi , I.0 ,ADCs

Diagnosis

• Delay in seeking medical advice.
• Delay in referral to gyn oncologists , Cancer centres .
• Radiology ( lots of machines , problems of interpretation ).
• Pathology and Genetic testing .

Education & Training

Surgery

• Suboptimal surgeries .

​

• Unjustified referral for NAC .

​

• Well trained gynecological oncologists , oncosurgeons .

Guidelines

Genetic testing

• BRCA.
• HRD ( Sponsored)
• Her2 neu, MMR ?
• NGS .

Systemic treatment

• Taxol/ platinum based .

​

• 6 cycles NAC?

​

• NAC without MDT

​

• Avastin.

​

• PARP inh.

​

• Immunotherapies , ADCs

Financial toxicity

Research & trials

Surveillance, recurrence

• Every 3 m ? 6 m ? Annual ?

​

• Clinical / markers / Radiology

​

• PET CT ?

​

• Recurrence management ?

​

• Palliative care , hospices .

EGOS recommendations : Working groups

Research & trials group

Registry group

Guidelines group

Education & Training group

Each group

• 8-10 members .
• Multidisciplinary , Geographical, gender representation .
• Leader from EGOS Board .
• Co-leader : 30-45 yrs .
• Each group leader to admit a report to EGOS board , general assembly annually.
• Each group to establish its SOPs before EGOS 2025.

• Cancer centers ( University centers , MOH centers ).

​

• ID linked .

​

• Private cases and patient, families ?

Registry group

• Fully support the accredited gynecological oncology programs .
• more centers to work hard on fulfilling the accreditation criteria then applying for accreditation .
• Asking the Egyptian medical council for a subspecialty gynecological oncology fellowship (already admitted to the council ) .
• Supporting specialties related to gynecological oncology and encouraging sub-specialization pathologists , radiologists , nurses …

Education & Training group

• Start with retrospective studies ??!!

​

• Prospective clinical trials .

​

• Multi -centers , Regional .

​

• International collaboration.

Research & trials group

• EGOS guidelines for Ovarian cancer management or following regional or source stratified guidelines ( Real guidelines with valid methodology ).
• Communication with the authorities for governmental and insurance support of target , immunotherapy with high evidence data for SIGNIFICANT oncological benefit.

Guidelines group

Health economics experts

Making the journey easier for the patients , HCP and the country

• Balance the diagnostic radiological modalities .

​

• Emphasis the maximal importance of MDT and specialized centers before starting treatment plan.

​

• Emphasis the importance of genetic testing and having more NGS and genomic profile assessment in Egypt.

​

• Assessing the real value of providing the new treatment modalities on the oncological outcome and health economics.