Recipient: Dr. Amy Jamieson, MBChB

Project: STRIVE Study – STRatIfication of Vulvar squamous cell carcinoma by HPV and p53 status to guide Excision

Primary Investigator(s): Dr. Amy Jamieson, Dr. Jessica McAlpine, Dr. Lily Proctor (Co-PI), Dr. Lynn Hoang (Co-PI), Dr. Emily Thompson (Co-PI), Dr. Sarah Hamilton (Co-PI)  

Summary: Vulvar cancer affects the external genitalia of women. This type of cancer is uncommon, arising mostly in older women, and has been neglected in research and clinical trials. Over the recent years, we have learned that the most common type of vulvar cancer; vulvar squamous cell carcinoma (VSCC) develops from pre-cancerous lesions via different pathways. One pathway is associated with human papillomavirus (HPV) infection, and another is related to chronic inflammatory skin conditions (and not HPV). The VSCCs arising from these two principal pathways; HPV- associated and HPV-independent, behave differently with different risks of recurrence, and different response to treatments. HPV independent VSCC are further defined by mutations in TP53, which identify a group of patients with very aggressive disease. Currently treatment is the same for all women with vulvar pre-cancer or cancer, and consequently many women may be overtreated, and many women are not treated enough. Given our evolving knowledge of this disease, this ‘one size fits all’ approach is no longer appropriate. Our aim in this study is to see if stratifying women with vulvar cancer based on HPV and TP53 status and altering their surgery and radiation treatment plans based on these molecular features will improve outcomes for women with this disease. 

Recipient: Dr. Gillian Hanley, PhD

Project: Improving quality of life and long-term health outcomes after risk-reducing surgery for hereditary cancer syndromes 

Primary Investigator(s): Dr. Gillian Hanley, Dr. Lesa Dawson, Dr. Janice Kwon 

Summary: Women at high genetic risk for ovarian cancer are advised to undergo risk-reducing surgery to remove their ovaries and fallopian tubes at a young age, which dramatically decreases the chance they will ever get ovarian cancer. However, these women will immediately enter menopause after their surgery which is recommended between the ages of 35 and 45, well before the average age of natural onset of menopause (51 years). Previous research has illustrated that premature menopause has both negative short- and long-term effects on a woman’s health. These short-term effects include severe hot flashes, night sweats, mood changes, sleep disturbances, reduced sexual functioning. The long-term effects include an increased risk of early onset osteoporosis, diabetes, and cardiovascular disease. Hormone replacement therapy (HRT) can reduce these short and long-term effects, however, many of these patients and their health care providers are uncertain if this can be used safely and finding the right HRT regimen often includes multiple adjustments. Thus, long-term compliance with HRT in this population is low. We implemented a “survivorship pathway” pilot at Vancouver Coastal Health in February 2021, to provide education and long-term follow-up care to these women. We will study whether this care improves HRT uptake, sustained use, menopausal symptoms and quality of life, and ultimately long-term health in this population. The early results of this successful pilot project highlight the health needs of this specific patient population, the positive impact on women’s lives, and it underscores the need to sustain this valuable resource. 

Recipient: Dr. Yvette Drew

Project: The Investigation into the utility of the PrOTYPE assay as part of the NEOCATS-Tx program* 

*NEOCATS –Tx: A translational program to support the phase 2, proof of concept NEoadjuvant Olaparib Combination OvArian Cancer Targeted Study 

Primary Investigator(s): Dr. Yvette Drew, Dr. Michael Anglesio (Co-PI), Dr. Aline Talhouk (Co-PI)  

Summary: The NEOCATS-Tx program will enable critical translational work to be undertaken on patient samples collected prospectively as part of the NEOCATS trial. It will improve our understanding better as to how and in which patients this novel treatment might work best. Specifically investigating the utility of the clinically validated, Vancouver developed PrOTYPE assay in this HRD biomarker negative HGSOC population before and after treatment. To determine if this assay is not only prognostic but predictive of a treatment response. The NEOCATS clinical trial proposal in itself is truly novel as it seeks to investigate for the first time a chemotherapy sparing approach to HGSOC in the neoadjuvant setting. Potentially shifting the paradigm in ovarian cancer away from platinum-based chemotherapy in the front-line setting. It will also investigate a novel biomarker driven, targeted treatment in the poorest patient group. If the trial is successful in meeting its primary endpoint demonstrating that this targeted triplet of Olaparib, Durvalumab and Bevacizumab is effective and safe, it is critical that we try to understand as much as possible how these treatments might be working together and develop biomarkers to determine who responds and who does not.