HJAR Jan/Feb 2024

HEALTHCARE JOURNAL OF ARKANSAS I  JAN / FEB 2024 43 Kathryn Kennedy, MD, FACOG Gynecologic Oncologist CARTI Cancer Center a clinical trial involving 817 patients. Those given the combination of the immunothera- peutic pembrolizumab (Keytruda) with the molecularly targeted therapeutic lenvatinib (Lenvima) had a median progression-free survival of 6.6 months, compared with 3.8 months among patients given chemothera- py. Although it will take more time and study to assess overall survival, early indications for these and other drugs currently in de- velopment are radically changing the gyne- cologic oncology landscape. Moving forward There were an estimated 66,200 new cas- es of uterine cancer diagnosed in 2023 in the U.S. alone, which are expected to result in around 13,030 deaths. Yet these cancers are, to a great degree, preventable and treatable. The answer? Talk to women about female reproductive health at all stages of life. Talk to women about the importance of a healthy weight. Talk to women about the HPV vac- cine. Talk to women, period. The more we encourage and normalize discussion around these issues, the more we can undo years of stigma and begin to put gynecological cancers behind us, too. n Kathryn Kennedy, MD, FACOG, leads the new gynecologic oncology service line at CARTI Cancer Center in Little Rock.The teamspecializes in treating an array of gynecologic conditions, including,but not limited to, preinvasive and invasive cervical cancer; endometrial cancer; endometrial hyperplasia; uterine sarcoma; established or suspected ovarian cancer; preinvasive and invasive vulvar disease; familial ovarian cancer; and more. surgery. The rising rate of uterine cancer is mainly attributed to obesity, which is a key risk factor leading to increased estrogen production and other issues. Simply put, obesity drives endometrial cancers. It can also make surgical treatments more chal- lenging. By achieving and maintaining a healthy weight through diet and exercise or other physician-supervised methods, pa- tients could help prevent cancer and cer- tainly lead to improved safety and better outcomes in the treatment of cancer and other serious health concerns. Of course, bariatric surgery comes with its own risks and should be thoroughly dis- cussed between patient and provider as one potential way to achieve a healthy weight for a multitude of health benefits. New advances in treatment Hysterectomy has been, and still often is, the go-to option for uterine cancers, al- though it isn’t right for everyone. However, now we are seeing exciting advances with molecularly targeted cancers and immuno- therapies in treatment. For example, the FDA approved in recent years a combination of a molecularly targeted therapy and an im- munotherapy to treat certain patients with advanced endometrial cancer whose disease progressed after prior systemic therapy, but who are not candidates for curative surgery or radiation. According to theAmericanAssociation for Cancer Research, the approval was based on Cancer Institute (NCI), researchers tallied endometrial cancer deaths in the U.S. from 2010 to 2017, accounting for hysterectomy prevalence. They found that deaths from endometrioid tumors had remained steady during that time, but the death rate from aggressive nonendometrioid tumors rose by 2.7% each year. Much like breast cancer, racial dispari- ties are evident across both subtypes. In the NCI-led study, Black women had consis- tently worse outcomes than other women with endometrioid and nonendometrioid tu- mors. While uterine cancer is slightly more common inWhite women, Black women are more likely to die from it. In fact, the over- all five-year survival rate forWhite women with uterine cancer is 84% versus 64% for Black women. That’s an alarming difference to say the least, and one that deserves much more study. Rethinking prevention Getting an annual pelvic exam every year for the rest of a woman’s life is one way pa- tients can protect themselves from gyneco- logic cancers. Another consideration is the HPV vaccine. It offers powerful protection that can prevent cervical and most vaginal and vulvar cancers in females, as well as penile cancer in males, and anal cancer and certain cancers of the mouth and throat for both females and males. The vaccine is now approved for women up to age 45. Now for the not-so-obvious tool: bariatric