Current Opinion in Obstetrics & Gynecology最新文献

Purpose of review: This review addresses the increasing recognition of genitourinary syndrome of menopause and its impact on sexual health, particularly as hormonal changes during menopause can lead to significant discomfort and dysfunction.

Recent findings: The literature highlights the multifaceted nature of sexual dysfunction in menopausal women, including genital/vulvovaginal, sexual, and urinary symptoms. Recent studies have explored the effectiveness of various treatments, including hormonal therapies, selective estrogen receptor modulators, and nonhormonal options such as hyaluronic acid and sexual devices. In addition to new guidelines on genitourinary syndrome of menopause published this year, there are some emergent papers highlighting experiences of menopause beyond the heterosexual, partnered, cisgender women which add to the discussion of sexual health in menopause for all.

Summary: Vulvovaginal health impacts sexual health by causing vaginal pain, irritation, and discomfort. There are many tools to address vulvovaginal health, including behavioral, nonhormonal, and hormonal options. Clinicians should be aware of the diverse treatment modalities available and how they can be used often concurrently to improve sexual health and well being in menopause.

Purpose: Artificial intelligence in human-assisted reproduction has attracted intense interest and inflated expectations, with proposed applications ranging from ovarian stimulation to gamete and embryo selection and outcome prediction. Despite the initial enthusiasm, its real-world clinical value remains uncertain. This review critically reassesses the current evidence to clarify where artificial intelligence meaningfully contributes and where expectations exceed demonstrated impact.

Recent findings: Most published studies show relevant methodological weaknesses, including limited reproducibility, poor external validation, scarce explainability, and weak comparison with standard clinical practice. Research efforts have disproportionately focused on embryo selection, an area with intrinsically constrained potential to improve treatment efficacy, while other clinically relevant domains remain underexplored. As a result, reported improvements often concern surrogate or intermediate endpoints rather than robust clinical outcomes.

Summary: Artificial intelligence holds greater promise in domains such as gamete assessment, automated data extraction, and personalized outcome prediction, where it may enhance treatment management, counselling, and decision-making for both clinicians and patients. Realizing this potential requires a strategic shift in research priorities and rigorous adherence to shared standards, including model transparency, uniformity, external validation, and benchmarking against established clinical workflows. Without such recalibration, artificial intelligence risks becoming a hyped technology with limited clinical relevance in assisted reproduction.

Purpose of review: Primary ovarian insufficiency (POI) is a disease that significantly affects the fertility, mental health, and physical health of up to 3.5% of women. Current evidence suggests a succinct diagnostic criteria, but there is limited information on who is at risk of this diagnosis as well as the optimal treatment options to prevent sequelae. The goal of this review is to synthesize the most recent available evidence on POI and provide the best recommendations for its management.

Recent findings/highlighted research: General consensus guidelines were recently updated and published, being affirmed by multiple specialties. This is the first update since 2015. Data continues to advance in terms of unique health risks, specifically in bone and cardiometabolic risks for these patients. Genetic advances have suggested that more complex testing may be of interest; however, this research is still developing.

Summary: Additional research is needed to determine which patients are most at risk for developing POI, the ideal treatment for its related health consequences, genetic testing to determine individual risk, and implications for long-term health.

Purpose of review: To provide an overview of endogenous and therapeutic estrogens, their receptor biology, clinical applications, and evolving safety considerations, with emphasis on how estrogen type, timing, and route of administration influence outcomes in menopausal hormone therapy (MHT).

Recent findings: Emerging research shows that estrogen receptor (ER)α, ERβ, and G protein-coupled estrogen receptor mediate distinct and sometimes opposing physiological effects. Updated analyses support the timing hypothesis, showing that starting MHT closer to menopause may yield cardiovascular and neurological benefits not observed with later initiation. Comparative studies demonstrate that estradiol has a more favorable thrombotic and metabolic profile than conjugated equine estrogens. Newer agents such as estetrol provide selective ERα activation with reduced hepatic stimulation and promising effects on vasomotor symptoms, bone turnover, and metabolic markers. Estriol has gained attention for its safety and effectiveness in treating genitourinary syndrome of menopause.

Summary: Estrogen therapy reflects a nuanced approach informed by receptor selectivity, pharmacologic diversity, and timing of initiation. Estradiol-based and transdermal formulations remain preferred for systemic therapy, while low-dose vaginal estrogen is first line for urogenital symptoms. Novel estrogens and deeper mechanistic insights continue to refine therapeutic options, supporting more targeted and safer use of estrogen across the menopausal transition.

Purpose of review: Cervical cancer remains the fourth most common cancer among women worldwide, predominantly affecting low- and middle-income countries because of limited access to human papillomavirus vaccination and screening. While early-stage disease can often be cured with surgery or chemoradiotherapy, the advanced or recurrent cervical cancer continues to have a poor prognosis.

Recent findings: Significant advances are transforming its treatment landscape. The addition of bevacizumab to chemotherapy has improved survival, and immune checkpoint inhibitors such as pembrolizumab and cemiplimab have shown significant benefits in both first- and later-line settings. In locally advanced disease, pembrolizumab combined with chemoradiotherapy (KEYNOTE-018) demonstrated unprecedented survival outcomes, leading to regulatory approval. Antibody-drug conjugates, particularly tisotumab vedotin, have also emerged as promising options for recurrent or metastatic cervical cancer, with ongoing studies exploring targets such as Human epidermal growth factor receptor 2 (HER2), trophoblast cellsurface antigen 2 (TROP-2), mesothelin, and nectin-4.

Summary: These developments reflect a shift toward precision medicine that integrates immunotherapy, antiangiogenic, and targeted agents; however, challenges persist in optimizing treatment sequences, overcoming resistance, and identifying biomarkers to personalize care. Addressing global disparities in prevention and treatment access remains essential to achieving the WHO's goal of eliminating cervical cancer by 2030.

Purpose of review: Mesothelin (MSLN) is a CA125-binding surface glycoprotein that mediates cell adhesion and peritoneal metastasis development in mesothelioma, high-grade serous ovarian cancer (HGSOC), pancreatic ductal adenocarcinoma, and cholangiocarcinoma.

Recent findings: Because of its tumor-restricted expression and functional role in dissemination, MSLN is represents an attractive molecule to target in solid tumors. Several antibody-based therapeutic agents, vaccine and chimeric antigen receptor therapy directed against MSLN are object of clinical evaluation. MSLN-targeted therapies are limited by antigen shedding and on-target/off-target effects.

Summary: MSLN is expressed in solid tumor patients, with no differences in expression among histologies. MSLN expression is associated with Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) stage and platinum sensitivity. Higher MSLN expression is detected among primary ovarian cancer patients and correlates with better survival data in HGSOC patients only. According to our data, treatment strategies targeting MSLN should be offered in first line setting rather than in relapse.

Purpose of review: Radiotherapy remains crucial to the management of gynecologic cancers. This review highlights recent advances in radiation delivery, integration with systemic therapies, and the evolving role of radiotherapy across definitive, adjuvant, recurrent, and palliative settings.

Recent findings: Trials in cervical cancer have established survival gains with novel systemic combinations, while adaptive and standardized radiation protocols continue to improve precision and outcomes. In endometrial cancer, molecular classification is informing adjuvant therapy selection and driving subtype-specific clinical trials. Expanding use of stereotactic body radiotherapy and proton therapy in ovarian and recurrent disease demonstrates feasibility and durable control. Efforts in reirradiation, palliative care, and survivorship underscore the need for safe dose escalation, symptom management, and long-term quality of life research. Persistent disparities and rising costs emphasize the importance of value-based and equitable care delivery.

Summary: Emerging imaging and adaptive techniques are making radiation for gynecologic cancers more precise and individualized. Advances in brachytherapy, stereotactic approaches, and proton therapy are refining delivery, while integration with systemic and molecularly guided strategies is broadening therapeutic impact. Ongoing priorities include reducing disparities, improving survivorship, and translating technological progress into accessible, patient-centered care.

Purpose of review: This review summarizes recent evidence in palliative care for patients with gynecologic malignancies, focusing on early integration, models of care delivery, and updates in symptom management and palliative procedures.

Recent findings: Early palliative care involvement, particularly more than 3 months before death, is associated with less aggressive end-of-life care and better alignment with patient preferences. Resource-adapted models, such as stepped approaches and telehealth, expand access to specialist palliative care while preserving quality. Advances in symptom management include olanzapine for cancer anorexia cachexia syndrome, nonopioid analgesics, and cell-free and concentrated ascites reinfusion. Procedural interventions near the end-of-life, such as palliative colostomy for malignant bowel obstruction, highlight the importance of shared decision-making and aligning treatments with patient values, goals, and preferences. Interdisciplinary care models, including nurse-led models such as the BOLSTER trial, further demonstrate benefit in supporting patients and caregivers, and the challenges with illness uncertainty in matching treatments to goals.

Summary: Evidence highlights strategies to integrate palliative care earlier, optimize resource use, expand symptom management options, and support patient-centered decision-making in gynecologic oncology.

Introduction: Cervical cancer is the fourth most common type of cancer found in women and the most common type of gynecologic cancer globally. Despite adequate prevention through the human papillomavirus vaccine, screening methods, and treatment strategies, cervical cancer remains one of the leading causes of morbidity and mortality. There are alarming disparities and geographical variations that exist among incidence rates and mortality of women with cervical cancer around the world.

Findings: The burden of this disease shows marked disproportions among incidence, mortality, and survival rates among high-income countries and low-income and middle-income countries. There are notable barriers to screening and prevention to include health literacy, education, and public awareness, societal and cultural factors, poverty and economic inequality, limited professional workforce capacity, and overall health infrastructure. These inequities emphasize a major global health concern.

Conclusion: Globally, there is a need for international participation to help in the fight to eradicate cervical cancer. The three regions with the highest rates of cervical cancer include Southeast Asia (including India), Latin America and the Caribbean, and Sub-Saharan Africa. This review article highlights the current methods of screening and prevention within these regions to combat the rising global epidemic that is cervical cancer.

Purpose of review: Breast cancer remains a leading cause of cancer-related morbidity and mortality worldwide. One of the most significant advances in treatment has been the evolution of human epidermal growth factor receptor 2 (HER2)-targeted therapies. This review summarizes recent clinical progress in HER2-directed antibody-drug conjugates (ADCs), with specific focus on trastuzumab deruxtecan (T-DXd) in breast and ovarian cancer, and highlights emerging ADCs shaping the next generation of HER2-targeted therapy.

Recent findings: T-DXd has demonstrated superior efficacy to trastuzumab emtansine (T-DM1) in breast cancer across the metastatic and adjuvant settings, and has also shown significant activity in HER2-low and ultralow disease. Mechanistic innovations, including a cleavable linker, a high drug-to-antibody ratio, and a membrane-permeable topoisomerase I inhibitor payload, enhance its potency. In ovarian cancer, T-DXd has shown promising early efficacy in heavily pretreated patients; however, additional real-world data are needed to better define its clinical benefit and optimize patient selection. Emerging HER2-directed ADCs such as disitamab vedotin aim to overcome resistance and broaden therapeutic options for patients.

Summary: The efficacy of T-DXd represents a major advance in HER2-targeted therapy, expanding treatment beyond HER2-positive disease into a wider continuum of HER2 expression. Ongoing clinical development of next-generation ADCs aims to improve efficacy, safety, and access to precision-guided cytotoxic therapy across solid tumors.