How Novel Adjuvant Treatments Are Reshaping Surgical Strategies in Gynecologic Oncology
Seance of wednesday 20 may 2026 (L'Académie reçoit la Société Francophone de Chirurgie Oncologique)
DOI number : 10.26299/zwyv-6g88/emem.2026.21.04
Abstract
The emergence of novel systemic therapies in gynecologic oncology is profoundly reshaping surgical strategies. Antibody-drug conjugates (ADCs), immunotherapy, and targeted therapies are now achieving deeper and more durable responses, even in initially advanced or borderline resectable disease. In mismatch repair-deficient (dMMR/MSI-H) endometrial cancers, the addition of immunotherapy to chemotherapy has demonstrated major progression-free survival benefits and high complete response rates. These findings raise the possibility of surgical de-escalation strategies in highly selected patients.
Experience from MSI-H rectal cancer, in which some patients can safely undergo a “watch-and-wait” strategy after complete clinical response to anti-PD1 therapy, further supports this paradigm shift in gynecologic oncology. However, several challenges remain, including the lack of perfectly predictive biomarkers, difficulties in response assessment during immunotherapy, the risk of pseudoprogression, and the absence of long-term prospective data.
Therefore, surgery currently remains the cornerstone of treatment. Nevertheless, integrating molecular profiling and novel therapeutic responses may ultimately lead to less extensive and more individualized surgical approaches, and potentially to surgery omission in carefully selected patients.
Experience from MSI-H rectal cancer, in which some patients can safely undergo a “watch-and-wait” strategy after complete clinical response to anti-PD1 therapy, further supports this paradigm shift in gynecologic oncology. However, several challenges remain, including the lack of perfectly predictive biomarkers, difficulties in response assessment during immunotherapy, the risk of pseudoprogression, and the absence of long-term prospective data.
Therefore, surgery currently remains the cornerstone of treatment. Nevertheless, integrating molecular profiling and novel therapeutic responses may ultimately lead to less extensive and more individualized surgical approaches, and potentially to surgery omission in carefully selected patients.