Dr. Cyrus Chargari | Vaginal & Vulvar Cancer

Описание: Join Cyrus Chargari, Head of Radiation Oncology at University Hospitals Pitié Salpêtrière, as he presents the 2025 update on vaginal and vulvar cancer at the OncoAlert Colloquium 2026.

In this session, Prof. Chargari reviews recent advances in radiotherapy, systemic treatment strategies, molecular stratification, and emerging immunotherapy data in these rare gynecologic malignancies.

Key topics covered:

1️⃣ Epidemiology and evidence gap:

• Vulvar cancer accounts for less than 6% of gynecologic cancers; vaginal cancer less than 2%.
• Vulvar cancer shows two incidence peaks: HPV-related younger patients and HPV-independent disease in older women (lichen-associated).
• Very limited prospective data; no randomized trials in vaginal cancer.
• 2023 European guidelines defined roles of surgery, radiotherapy, and brachytherapy, but systemic evidence remains extrapolated mainly from cervical cancer.

2️⃣ Advances in nodal management (vulvar cancer):

• Prospective data on image-guided surgical navigation for sentinel lymph node detection.
• Improved identification in technically challenging cases (high BMI, deep nodes).
• Potential to reduce need for complete inguinofemoral lymphadenectomy.

3️⃣ Molecular stratification and prognosis:

• 2025 meta-analysis confirms three prognostic groups in vulvar squamous cell carcinoma:
• HPV-positive: best prognosis
• HPV-negative / TP53 wild-type: intermediate risk
• TP53-mutated: worst prognosis
• Molecular profiling increasingly relevant for risk stratification.

4️⃣ Metastatic vulvar cancer – systemic therapy insights:

• NCDB analysis (over 700 metastatic patients):
• Lymph-node–only metastasis associated with better prognosis.
• No clear advantage of multi-agent over single-agent chemotherapy.
• Combined chemoradiotherapy superior to single modality in nodal-only metastatic disease.

5️⃣ Emerging role of immunotherapy:

• Phase II basket trial of pembrolizumab + vorinostat in recurrent/metastatic vulvar and vaginal cancers:
• High response rate (~90% disease control), though short median duration (~3 months).
• HPV-positive status and high tumor mutational burden correlated with improved outcomes.
• Phase II study (ASCO 2025) combining chemoradiation + pembrolizumab in locally advanced vulvar cancer:
• 6-month RFS ~70%, overall response rate 75%, complete response 37%.
• Promising but investigational; not practice-changing.

6️⃣ Vaginal cancer updates:

• Randomized phase III trial evaluating triapine + cisplatin chemoradiation: negative results.
• Continued emphasis on modern radiotherapy and brachytherapy techniques to optimize local control and reduce morbidity.

7️⃣ Practice implications (2025):

• No practice-changing trial this year.
• Growing importance of molecular classification in vulvar cancer.
• Increasing use of dose escalation strategies in advanced disease.
• Immunotherapy showing early signals of activity but remains investigational.

8️⃣ What’s coming in 2026:

• Ongoing trials evaluating radiotherapy intensification and surgical modifications.
• Prospective studies combining chemoradiation with immunotherapy.
• Early-phase trials exploring novel systemic strategies in metastatic disease.