Bold start: A breakthrough in vulvar cancer care is now expanding across Aotearoa New Zealand, aiming to tailor surgery to the biology of each tumor. But here’s where it gets controversial: could less invasive and more personalized approaches truly match or surpass traditional wide-margin surgeries? This is exactly what the STRIVE trial is designed to test.
Overview
The STRIVE trial—Stratification of Vulvar Squamous Cell Carcinoma by HPV and p53 status to Guide Excision—has opened locally in Aotearoa New Zealand. It’s a collaborative effort led internationally by the Canadian Cancer Trials Group (CCTG) and locally by the Australia New Zealand Gynaecological Oncology Group (ANZGOG). Professors Paul Cohen and Lois Eva serve as ANZGOG’s Study Co-Chairs for the region. The trial investigates whether surgical decisions for vulvar squamous cell carcinoma (VSCC) can be refined by tumor biology, particularly HPV status and p53-related markers.
What STRIVE Does
- STRIVE is a prospective international study that aims to refine how surgeons decide the extent of excision in primary VSCC based on tumor biology.
- It seeks to compare outcomes for HPV-associated VSCC versus HPV-independent VSCC, with the goal of personalizing treatment and reducing unnecessary surgery.
- The trial will estimate 3-year local recurrence rates in patients managed according to differentiated vulvar intraepithelial neoplasia (dVIN) and p53 status, alongside tumor margin clearance.
Why this matters
VSCC is the most common vulvar cancer, making up over 90% of cases, and most often affects postmenopausal women. VSCC can develop via two main pathways:
- HPV-associated, generally more responsive to targeted, less aggressive surgical approaches.
- HPV-independent, frequently linked to chronic inflammatory conditions such as lichen sclerosus, which may require different management.
Key insights guiding the trial include:
- HPV-associated cancers may have better prognosis and potentially permit less extensive surgery and wider margins or repeat procedures that are avoided if not needed.
- HPV-independent cancers connected to lichen sclerosus may harbor edge-tissue abnormalities (like p53 mutations and dVIN) that could raise recurrence risk if not treated adequately.
- The trial questions whether a laboratory‑informed surgical plan can reduce side effects, preserve function, and avoid disfiguring procedures without compromising cancer control.
What STRIVE hopes to achieve
- Improve risk stratification to tailor surgical plans per tumor biology.
- Reduce local recurrence rates through more precise margin assessment.
- Generate evidence to guide clinical guidelines for VSCC treatment.
- Promote personalized treatment pathways for vulvar cancers.
Clinical practice implications
Because vulvar cancer is relatively rare, international collaboration is essential. STRIVE brings together global experts to strengthen evidence and improve outcomes for women affected by VSCC.
Eligibility and sites
- Eligible participants: Adult women with primary VSCC, FIGO stage I–II.
- The trial opened in Canada on October 1, 2024, with eight international sites active and 13 participants enrolled so far.
- The Australasian site at Auckland City Hospital opened January 30, 2026, and is actively recruiting, with Dr. Lois Eva as Principal Investigator for the region.
Registration and contact information
- ClinicalTrials.gov: NCT06358469
- ANZCTR: details updated periodically; link available on request
For more information
- ANZGOG: www.anzgog.org.au
- Video summary: https://youtu.be/xZdSn0JPwWY
Media and research inquiries
Media contacts and researchers seeking further details should reach out to the ANZGOG media team or the designated press contact for updates.
Closing thought
STRIVE represents a pivotal step toward evidence-based, biology-driven surgical decisions in VSCC. It challenges the one-size-fits-all approach and invites clinicians and patients to consider how tumor biology could shape safer, more effective care. Do you think treatment should be more conservative for HPV-associated VSCC, and more aggressive for HPV-independent cases based on molecular findings? Share your thoughts in the comments.
