LAUSR

The aim in modern gynaecological oncology is individualised treatment. Evolution of molecular diagnostics has made a major contribution towards this aim by categorising malignancies by their molecular characteristics. This results in the highest probability of an individualised therapeutic response and the lowest possible spectrum of side effects. Molecular parameters can be used for subclassification, diagnosis, prognosis and monitoring of therapy response. Probably one of the long-established molecular markers in gynaecological oncology is the hormone receptor status in breast cancer. Since the 1970s, a positive hormone receptor stocking represents the indication for anti-hormonal therapy in breast cancer patients. Since then, a continuously growing number of molecular factors in breast cancer have been identified. A current example is the PIK3CA specific inhibitor alpelisib, which enables targeted therapy in routine breast cancer treatment (Hofmann et al. 2014; Shah et al. 2015; Jain et al. 2017). Other examples include the use of PARP inhibitors in BRCA mutated ovarian cancer therapy (Pilie et al. 2019) and the application of a molecular subclassification system of endometrial cancer to optimise therapeutic decisions (Kandoth et al. 2013). Beyond these factors and therapeutic modalities, there is a broad spectrum of promising new therapeutic approaches being under investigation as non-invasive physical plasma (NIPP). This procedure induces multiple protherapeutic local cell responses in NIPP treated tissue, is extremely well tolerated and minimally invasive (Stope 2020). The basis of all these clinical advances is molecular and cell biological research. This in turn requires a close integration of clinical and experimental approaches. Without a gynaecological background, tumour biological research will miss the requirements of gynaecological oncology and will not be able to transfer the results into clinical practice. Other oncology specialties are often more advanced than gynaecology in this regard. For example, haematology and urology departments often have oncology research laboratories, and the trade associations organise support, e.g. in the form of research grants and experimental oncology meetings. It is therefore imperative that gynaecological oncology departments carry out their own research, run their own laboratories and recruit their own gynaecologically qualified scientists. If patient samples are given to a genetic or biochemistry department for analysis, then genetic or biochemical research is primarily carried out and consequently genetic or biochemical questions are answered. This is not to say that cooperation with partners should be rejected. However, it is important, especially in interdisciplinary collaborations, to clearly formulate the translational goals and to keep them in mind. This approach includes a further essential requirement. Clinicians must have a solid scientific background and be prepared to be familiar with the latest scientific knowledge in their field. Considering the increasing importance of molecular biology in modern individualised oncology, scientific education in addition to clinical education is essential. In this regard, the new concept of the clinical scientist, which has already found its way into many universities as a structured support program, is very promising. The concept of clinical researchers has now been established at research institutions throughout the Western Hemisphere, for example, at the Departments of Obstetrics and Gynecology at Stanford University (US), The University of Sheffield (UK) and the University of Bonn (Germany). The prerequisites for this career path include personal factors such as an appropriate level of education, a supportive family environment, and personal commitment and interest. Furthermore, institutional factors must also be in place. These include financial and infrastructural resources as well as training programs, mentoring and active networks. Often, these training programs are designed to accompany the career and, in the best case, begin during medical school and continue until the highest professional qualification is achieved. The goal is usually the establishment of an own translational research group in the institution (Rubio et al. 2011). The goal is longterm scientific qualification alongside clinical activity and profiling. This costs resources, especially time. However, gynaecologists should conduct their gynaecological research themselves, and medical management should support and encourage these opportunities. This can be both demanding and expensive, but if you want research in gynaecology, you also have to support the (clinical) researchers.