Vulvar Cancer Treatment: A Game-Changer for Women's Health?
Exciting news for women's health in Aotearoa New Zealand! The STRIVE clinical trial, a groundbreaking international study, has officially launched, aiming to revolutionize the way we treat vulvar cancer. But here's where it gets controversial: could less surgery actually mean better outcomes for certain patients?
The Australian New Zealand Gynaecological Oncology Group (ANZGOG), in partnership with the Canadian Cancer Trials Group (CCTG), announced the local opening of the STRIVE clinical trial (Stratification of Vulvar Squamous Cell Carcinoma by HPV and p53 status to Guide Excision) on March 4, 2025. This trial represents a significant leap forward in evidence-based surgical management for women diagnosed with vulvar squamous cell carcinoma (VSCC), the most common form of vulvar cancer, accounting for over 90% of cases. Primarily affecting postmenopausal women, VSCC develops through two main pathways: HPV-associated or HPV-independent, with the latter often linked to chronic conditions like lichen sclerosus. Symptoms can include persistent itching, bleeding, and ulcerated lesions, typically on the labia.
And this is the part most people miss: Recent research suggests that HPV-associated VSCC behaves differently than HPV-independent cases, often being less aggressive with a better prognosis and fewer recurrences. This raises the question: could HPV-associated cancers be effectively treated with less invasive surgery, avoiding wide margins or repeat procedures? While existing studies hint at the safety of reduced surgery, STRIVE is the first trial to formally investigate this, potentially leading to fewer complications, better function, and less disfiguring outcomes.
Conversely, HPV-independent tumors, often arising from lichen sclerosus, may require more aggressive treatment. Evidence suggests that if the underlying conditions (abnormalities in the p53 gene and pre-cancerous changes called differentiated vulval intraepithelial neoplasia, or dVIN) are present at the tissue edges after removal, the risk of recurrence increases. STRIVE aims to clarify the best treatment approach for both types of VSCC.
The Study's Goals:
STRIVE is an international, prospective stratification study designed to refine surgical decision-making based on tumor biology. Led globally by CCTG and locally by ANZGOG, with Professor Paul Cohen and Dr. Lois Eva as ANZ Study Co-Chairs, the trial has several key objectives:
- Estimate 3-year local recurrence rates in patients with HPV-associated and HPV-independent VSCC, managed surgically according to dVIN/p53 status and tumor margin clearance.
- Inform stratified surgical approaches to support personalized care pathways.
- Address critical gaps in understanding the biological determinants of recurrence in VSCC.
Why This Matters:
Data from STRIVE will:
- Improve risk stratification for surgical management.
- Reduce local recurrence rates.
- Support evidence-based margin assessment.
- Strengthen clinical guidelines for VSCC treatment.
- Promote personalized treatment approaches for vulvar cancers.
Given the rarity of vulvar cancer, international collaboration is crucial. STRIVE brings together global expertise to enhance clinical evidence and improve outcomes for affected women.
Current Status:
STRIVE opened in Canada on October 1, 2024, and has since expanded to eight international sites, enrolling 13 participants. The first Australasian site at Auckland City Hospital opened on January 30, 2026, with Dr. Lois Eva as Principal Investigator, and is actively recruiting participants.
Eligibility:
Adult women diagnosed with primary vulvar squamous cell carcinoma (VSCC), FIGO stage I–II disease, are eligible to participate.
Get Involved:
For more information, visit STRIVE Trial Video or ANZGOG Website.
Thought-Provoking Question:
As we move toward personalized medicine, how do we balance the need for rigorous clinical trials with the urgency of providing the best possible care to patients today? Share your thoughts in the comments below!
About ANZGOG:
The Australia New Zealand Gynaecological Oncology Group (ANZGOG) is the leading national gynaecological cancer research organization for Australia and New Zealand. Our mission is to improve outcomes and quality of life for everyone affected by gynaecological cancer through clinical trials and multidisciplinary research. Learn more at ANZGOG.org.au.
Media Contact:
Monique Cerreto
E: [email protected]
P: +61 0416 282 464
