The phosphatase and tensin homolog-phosphoinositide 3-kinase (PI3K)-protein kinase B (AKT) pathway is frequently altered in gynecological tumors, notably in endometrial cancer where PIK3CA mutations are found in nearly half of patients. Despite this, evidence of clinical activity of PI3K inhibitors in endometrial cancer is poor and limited. Alpelisib, an oral PI3K alpha-selective inhibitor, showed encouraging preliminary activity in advanced gynecological tumors harboring PIK3CA alterations. Inavolisib is a highly potent and selective PI3K inhibitor.

Recurrent epithelial ovarian, fallopian tube, and primary peritoneal carcinoma is usually managed as a systemic disease, yet some patients present with limited-volume recurrent, persistent, or progressive disease that appears amenable to local treatment. This clinical state is variably described as oligometastatic, oligorecurrent, oligoprogressive, or locoregional recurrence. Whether it represents a distinct biologic state, a radiologically defined disease pattern detected by modern imaging, a treatment-selection construct, or a mixture of these remains un-resolved. The issue has become more clinically relevant because advances in systemic and maintenance therapy, imaging, supportive care, and selected use of surgery have extended survival and increased detection of limited-site recurrence. This narrative review evaluates evidence for secondary cytoreductive surgery or metastasectomy, stereotactic body radiotherapy, and image-guided ablation in oligometastatic or oligorecurrent epithelial ovarian cancer, with systemic therapy considered as the therapeutic context in which local treatment is selected. Its objective is to clarify the populations, end points, and limitations of each evidence base to support individualized multi-disciplinary decision-making. The evidence is not directly comparable: randomized surgical trials enrolled selected patients with platinum-sensitive, resectable recurrence rather than uniformly defined oligometastatic disease; stereotactic body radiotherapy studies selected technically treatable lesions, often nodal; and ablation reports are small, liver-predominant, and mostly retrospective. Surgery is the only local modality tested in phase 3 randomized trials, whereas stereotactic body radiotherapy and ablation primarily demonstrate treated-lesion control and, in selected cohorts, delay to the next systemic regimen; patient-level survival benefit remains unproven. Decisions should integrate histotype, platinum sensitivity, prior systemic and maintenance therapy, lesion number and distribution, technical feasibility and morbidity, symptoms, quality-of-life priorities, and patient preference.

Atypical endometrial hyperplasia/endometrioid intra-epithelial neoplasia is the main precursor of endometrioid endometrial carcinoma. Its histopathological spectrum is heterogeneous, and inter-observer reproducibility remains sub-optimal. An integrated histological model combining cytological atypia and architectural complexity has been proposed to improve risk stratification for concurrent carcinoma.

Dexamethasone is a glucocorticoid routinely used as pre-medication during carboplatin-paclitaxel chemotherapy for ovarian and endometrial cancer treatment. However, its repeated administration may contribute to metabolic disturbances, including hyperglycemia. This study evaluated the association between cumulative dexamethasone exposure and longitudinal changes in random blood glucose levels in patients with ovarian or endometrial cancer. We conducted a retrospective study of patients with ovarian or endometrial cancer who received dexamethasone during chemotherapy between November 2012 and November 2025 and had available random glucose measurements. Linear regression assessed associations with body mass index, baseline diabetes status, and cumulative dexamethasone exposure. Overall, 150 patients with ovarian cancer and 150 patients with endometrial cancer were included. Ovarian cancer patients had a median body mass index of 25.1; patients with endometrial cancer had a median body mass index of 28.1. The median cumulative dexamethasone dose was 186 mg. Patients with endometrial cancer showed a higher burden of hyperglycemic events. In the endometrial cancer cohort, both pre-treatment glucose (odds ratio 1.47, 95% confidence interval 1.09 to 2.00, p = .012) and baseline diabetes status (odds ratio 5.85, 95% confidence interval 1.80 to 18.95, p = .003) were independently associated with pre-diabetic or diabetic spikes. These findings highlight the need for vigilant glucose monitoring during chemotherapy, particularly in patients with endometrial cancer with elevated body mass index. Larger prospective studies are warranted to confirm these observations.

Cervical cancer is caused by persistent high-risk human papillomavirus (HR-HPV) infection and remains a major global health burden despite available preventive strategies. Most HR-HPV infections and associated low-grade squamous intraepithelial lesions (LSIL) regress spontaneously, yet increasing commercial promotion of topical therapies targeting HPV clearance has emerged in clinical practice. This FIGO/International Gynecologic Cancer Society (IGCS) Position Statement critically appraises the available evidence on topical treatments for HR-HPV infection and LSIL, and provides evidence-based recommendations for clinical practice and future research. No randomized controlled trial has been adequately designed or powered to evaluate the effect of topical therapies on the prevention of histologically confirmed high-grade squamous intraepithelial lesions (HSIL/CIN3+). Available studies are characterized by small sample sizes, short follow-up periods, heterogeneous populations, inadequate comparators, and reliance on surrogate endpoints of uncertain clinical relevance, including cytological regression, HPV nondetection, and immunohistochemical markers such as p16/Ki-67. Published meta-analyses reporting statistically significant improvements in virological and cytological surrogates are limited by substantial heterogeneity, publication bias, and follow-up periods under 1 year. Product-specific appraisal of Coriolus versicolor-based and silicon dioxide/selenite-based vaginal gels reveal additional methodological concerns, including retrospective trial registration, industry funding, and misinterpretation of findings consistent with the spin phenomenon. In the absence of high-quality evidence demonstrating clinically meaningful benefit, FIGO and IGCS do not endorse the routine clinical use of any currently available topical agent for HR-HPV infection or LSIL. Evidence-based surveillance remains the standard of care. Future research should prioritize rigorous trial design with histologically confirmed HSIL/CIN3+ as the primary endpoint, adequate follow-up of at least 3 years, and appropriate comparators. Clinical management should center on informed shared decision-making and evidence-based counseling, rather than on interventions lacking proven clinical benefit.

Human papillomavirus is the most common sexually transmitted infection and the necessary cause of cervical cancer, as well as a proportion of other anogenital and oropharyngeal cancers. Although most infections clear spontaneously, persistent oncogenic human papillomavirus infection may lead to precancer and cancer. There is therefore a need for effective and globally accessible therapies that either promote sustained clearance of human papillomavirus infection or safely treat human papillomavirus-related lesions, particularly in settings where ablative or excisional procedures are not readily available. However, no therapy has demonstrated proven and durable efficacy in eradicating human papillomavirus infection itself, although some non-ablative interventions have shown efficacy in treating specific human papillomavirus-related lesions. We conducted a narrative review of currently available and emerging interventions promoted for the treatment of human papillomavirus infection or human papillomavirus-related lesions, including approved topical agents, oral formulations, immunotherapies, therapeutic vaccines, molecular inhibitors, and widely marketed commercial products. Evidence was synthesized from clinical trials, systematic reviews, clinical guidelines, health technology assessments, and policy recommendations, and assessed using a structured evidence-evaluation framework. Some agents, including immune modulators and sinecatechins, are approved for external anogenital warts but do not reliably eliminate underlying human papillomavirus infection. Selected topical therapies, particularly 5-fluorouracil, have demonstrated efficacy in randomized trials for regression of cervical intraepithelial neoplasia in specific clinical contexts, but do not represent validated antiviral eradication therapies. Photodynamic therapy, intralesional immunotherapy, therapeutic vaccines, and molecular inhibitors remain investigational, with insufficient evidence for routine clinical use. Probiotics, nutritional supplements, vaginal gels, and other commercially promoted products also lack robust evidence. In the absence of proven therapies that eradicate human papillomavirus infection, current management relies on surveillance, evidence-based treatment of precancerous lesions, vaccination, and screening. The proposed framework may support professional societies in evaluating emerging interventions and providing clear, evidence-based guidance to health care professionals, policymakers, patients, and the public.