EOTTD newsletter May 2023

As an attempt to reach the members of EOTTD and others interested in the field of GTD, the EOTTD board will publish regular updates on upcoming meetings, updates from the working parties and other current events or news, in regular newsletters. If you are interested in a special topic or want to add something in the newsletter, please contact the EOTTD board.

EOTTD Membership

EOTTD is an academic organization with the mission to improve management of patients with GTD in Europe. Membership of EOTTD is encouraged for anyone with an interest in the field of GTD or treating GTD patients. Some of the benefits of a membership are regular updates including the newsletter, possibility to take part in working parties and journal clubs, meeting discounts and access to meeting presentations and recordings. The yearly fee is 50 euros for a full membership and 25 euros for nurses and trainees. For more information, please see the EOTTD website eottd.org.

Updates from the working parties

1. Clinical working party

   The clinical working party continues to work on the joint international clinical guidelines for GTD based on the published EOTTD clinical guidelines together with representatives from ESGO (European Society of Gynecological Oncology), ISSTD (International Society for the Study of Trophoblastic Diseases) and GCIG (Gynecological Cancer InterGroup). A one-day hybrid meeting was held on May 11 prior to the 11th EOTTD meeting in Warsaw. The clinical working party also met on May 13 and discussed clinical patient cases to be put on the website for educational purposes.

2. Pathology and genetics working party

   The pathology and genetics working party also met on May 13 and celebrated that the EOTTD guidelines on diagnostics of hydatidiform moles now are ready for publication. Many pathologists and geneticist have contributed over time, however Carla Bartosh finalized the work. The plan is to continue with guidelines on the diagnostics of GTN. Other ideas that were discussed were:

   • Strengthening the online MDT/QA events which have been such a success that we ran out of time at the latest event. Discussion on dividing the meetings or having longer or more frequent meetings. The next event will be 15th of June 15:00
   • Making an overview of biobanks with material relevant for research in GTD
   • Writing newsletters on research
   • Arranging focused courses on specific topics

3. Biochemistry working party

   The hCG working party convened on May 13 in Warsaw.

   Earlier this year, working party members wrote a manuscript for the special EOTTD issue of the journal Gynaecological and Obstetric Investigations (“ Measurement of hCG in women with Gestational Trophoblastic Disease”, authored by Lesley M. McMahon, Caroline M. Joyce, Lyndsey Cuthill, Hugh Mitchell, Imran Jabbar, Fred C.G.J. Sweep on behalf of the hCG working party of the EOTTD). The paper presents data from our survey amongst EOTTD affiliated laboratories on hCG, in which we defined and discussed minimum requirements for hCG testing/assay, discussed pros and cons of centralised and non-centralised hCG testing, and presented some typicial clinical and laboratory cases and challenges. In the absence of hCG centralisation we feel a strong need to educate labs about limitations of commercial assays, and necessity of participation in EQA schemes.

   Regarding the 1-year plan as defined in the EOTTD Cork meeting in 2022 we concluded that we achieved two out of our three goals (survey and publication). The remaining goal focused on harmonisation studies and we discussed how to proceed with this (see 5-year plan).

   A 5-year plan was defined:

   Organize Harmonisation Study between EOTTD hCG laboratories: Contact survey participants and invite them to do a sample exchange, multi-center twin-studies

   Define normalisation levels for each assay

   Communicate with labs on pre-analytical factors affecting hCG measurement (temperature, haemolysis, stability)

   Evaluate alternative collection methods/assays (studies on capillary blood sampling, dried blood spots/LC-MS.

4. Nursing working party

   The nursing working party also met on May 13 onsite in Warsaw. Several topics were discussed and are summarized below:

   Best practice nursing guidelines are accepted for publication, and centres now need to consider how they will adopt these and use in their clinical areas. They are encouraged to contact the EOTTD nurses’ group if they need guidance.

   Health inequalities and the impact on the bigger centres -eg challenges with language, refugees and supporting this patient group with the additional needs and patients not engaging with the support offered.

   Nursing research- the barriers, time constraints, lack of involvement given by medical colleagues, or not our own nursing projects (how can we change our mind sets)

   Lack of funding for nurses to attend these meetings. EOTTD will support funding for nurses if some centres are struggling, to get in touch.

   Lack of nursing representative – the nursing group has not grown. Encouraged our medical colleagues to bring their nurses.

   Forward planning- nurse specific e-learning online modules, one nurse champion in each EU country. Suggestions for London to put their challenging case presented at the EOTTD meeting the day before on website.

   The nursing lead role will be rotated and Lotte Boog (Amsterdam, the Netherlands) has expressed an interest for next year.

Meetings

The 11th annual EOTTD meeting was finally held in Warsaw, Poland on May 12 to 13, 2023. This meeting venue had been postponed from 2022 due to the unsafe conditions in parts of Europe, and instead moved to Cork, Ireland for the 2022 meeting. This year, however, the colleagues from Warsaw hosted a splendid and well organized hybrid meeting with most participants onsite. The meeting pre-started on May 11 with a full day of continued work on the joint international clinical guidelines together with ISSTD, ESGO and GCIG. 

The EOTTD meeting on May 12 included a very interesting and comprehensive scientific program. For the first time young investigators were invited to present projects. There was also a poster exhibition and the poster abstracts are attached to this newsletter. The networking activity included many delicacies and a legendary piano bar! May 13 was dedicated to the continued work of the respective working parties which is updated above. The next EOTTD meeting will take place in Stockholm, Sweden, and the future organizers will have a hard time trying to match the successful Warsaw meeting.

Upcoming meetings:

Teaching sessions

As a part of an outreach program to facilitate the establishment of new GTD centres, the board members of the EOTTD hold teaching sessions in hospitals which have expressed an interest in improving care of GTD patients. Anyone interested in hosting a teaching session should contact a member of the board. The two board members mostly involved in planning of the teaching sessions are listed in the beginning of this newsletter and on the EOTTD website eottd.org.

Upcoming teaching sessions

Spring field trip to Sheffield and London

On the international women’s day on March 8, part of the GTD team at Karolinska University Hospital in Stockholm, Sweden conquered a full winter storm in an insufficiently sized plane in order to participate in the GTD conference held by the Sheffield GTD team and to visit the U.K GTD centres in Sheffield and London. They brought the winter weather to the U.K, but despite that had a very productive and rewarding visit bringing home much useful information and of course a wonderful time with friends and colleagues from the hosting centres.

EOTTD Traineeship (a visiting scholar and mentorship program)

The EOTTD aims at improving the management for patients with GTD in all European countries. This goal is accomplished through a variety of activities. Since there are differences in the development of centres dedicated to the treatment of GTD within Europe, EOTTD wants to introduce a new program providing trainees and early career specialists an opportunity to visit and witness the working of more established units so they may identify improved resource utilization in their own setting.

In this way EOTTD is creating opportunities for trainees/early career professionals to visit more established centres with specific goals of seeking mentorship.

Topics that can be learned in this program:

• Multidisciplinary team management and governance

• The diagnostic process in GTD

• Research and clinical trial design

• Proper hCG management

• Treatment of high and ultrahigh risk patients

• Pathology and Genetics in GTD

The duration of the traineeship is 1-2 weeks, and the maximum number of yearly positions is four. Centres that can be visited are London, Sheffield, Amsterdam/Nijmegen, Lyon and Stockholm. EOTTD will give financial support to every approved traineeship with 500 euros. The applicant should present his/her resume and the goal(s) of the proposed visit to the EOTTD board as part of the application process.

Journal club

The EOTTD aims at introducing a regularly recurring journal club in which all EOTTD members are welcome to participate. The idea is to choose a recent or in other ways important publication which will be discussed. More information about this will be published on the website as soon as the format and dates are decided.

New and selected publications on GTD 2023 (second selection in 2023)

• Gestational Trophoblastic Disease: Best Practice Nursing Guidelines.
  Kam Singh, Sarah Rollins, Jane Ireson
  Gynecol Obstet Invest. 2023 Apr 11.
  PMID: 37040714

• When to consult a geneticist specialising in gestational trophoblastic disease.
  Lesley McMahon, Geoffrey J Maher, Caroline Joyce, Isa Niemann, Rosemary Fisher, Lone Sunde
  Gynecol Obstet Invest. 2023 May 26.
  PMID: 37245506

• Current chemotherapeutic options for the treatment of gestational trophoblastic disease.
  Antonio Braga, Gabriela Paiva, Cassia Juliana Cattai, Kevin M Elias, Neil S Horowitz, Ross S Berkowitz.
  Expert Opin Pharmacother. 2023 Feb;24(2):245-258.
  PMID: 36399723

• Novel approaches to managing gestational trophoblastic tumors in the age of immunotherapy.
  Lindsay Hennah, Michael Seckl, Ehsan Ghorani.
  Int J Gynecol Cancer. 2023 Mar 6;33(3):414-419.
  PMID: 36878565

• Leptomeningeal disease as a presenting feature of gestational trophoblastic neoplasia: A review and recommendations for management.
  B Hapuarachi, J A Tidy, C Romanowski, K Singh, S Gillett, J Ireson, M C Winter.
  Gynecol Oncol. 2023 May;172:47-53.
  PMID: 36934478

• Challenging gestational trophoblastic disease cases and mimics: An exemplar for the management of rare tumours.
  M Hamid, C M Joyce, H K Carroll, C Kenneally, S Mulcahy, Mary-Kate O'Neill, J Coulter, S O'Reilly.
  Eur J Obstet Gynecol Reprod Biol. 2023 May 13;286:76-84.
  PMID: 37224702

Upcoming EOTTD publications:

• Special issue in Gynecology and Obstetrics in 2023
  Planned chapters:

  1. Editorial
  2. The development of hCG testing and the need for reference laboratories.
  3. Expert pathology for GTD: towards a international multidisciplinary MDT.
  4. Exposure and centralization of GTD care: the elephant in the room.
  5. Immunotherapy for GTN: why and when it works.
  6. Consequences of GTD treatment for patients
  7. Surgical treatment of GTD
  8. From national to international collaboration in GTD: hurdles and possibilities
  9. Why to consult a geneticist in GTD
  10. The rare if the rarest: PSTT, ETT, APSN
  11. 11. Controversies in GTN (describing the debates)
  12. Mismanagement of GTN (10 cases of not well handled GTN)