What are your top takeaways from SGO 2023?

There were many great presentations at SGO 2023 along with a few practice changing presentations. Two pivotal randomized phase III clinical trials enrolled advanced, metastatic endometrial cancer patients. Each demonstrated dramatic benefit with the addition of immunotherapy to chemotherapy (followed by immunotherapy), regardless of mismatch repair status. Adverse events were reported to be manageable, consistent with that of the individual drugs. Shortly after the presentations, the manuscripts were published online in the NEJM.^1,2

Preamble to the NRG-GY018 SGO presentation:

On February 3, 2023, a letter signed by Robert Mannel MD, NRG Oncology Group Chair was emailed to clinical investigators re: NRG-GY018 stating: “You are receiving this l...

1. GOG-3026 Phase II trial Letrozole = Ribociclib of low grade ovarian cancer. This gives us another treatment for this disease to be added to hormonal therapy and MEK inhibitor trametinib.
2. All of the abstracts on Circulating cell free DNA analysis. These usher in a new era of real-time genetic evaluation of the cancers we treat. It could also lead to screening for cancers and early detection.
3. The presentation of NRG-GY018… pembrolizumab plus carbo taxol for endometrial cancer. This establishes a new standard for treatment of advanced and recurrent endometrial cancer.

I found the NOW trial to be the most provocative of the studies presented that I was able to attend.

In this study, the authors were trying to determine the feasibility of olaparib in the neoadjuvant setting for ovarian cancer. Patients had a germline BRCA1/2, RAD51C/D, or PALB2 mutation and high grade serous ovarian cancer with no prior treatment who were undergoing NACT with a planned interval cytoreductive surgery. Enrolled subjects received two cycles of neoadjuvant olaparib alone. If a response was noted, they then had an interval debulking followed by adjuvant paclitaxel and carboplatin and PARPi maintenance. Non-responders received neoadjuvant paclitaxel and carboplatin before an interval cytoreductive attempt. Fifteen patients rece...

1. Late breaking IO in endometrial cancer
2. Ribo + letrozole - GOG-3026… not earth-shattering but we all need more therapy options for LGSC, happy to see this data supporting another option/line.
3. New staging for endometrial cancer presentation - not live yet, but a lot of information to digest so good to start familiarizing now!

1. NRG-GY018 (Dr. @Dr. First Last) and RUBY (Dr. Mirza) are prospective clinical trials that change the way we approach the treatment of metastatic and recurrent endometrial cancer. Immunotherapy use will expand greatly as we see significant benefits for patients with MMR proficient and MMR deficient tumors. Questions in the future will include whether immunotherapy alone can take the place of chemotherapy/immunotherapy combination for MMR deficient tumors in the initial management of metastatic or recurrent disease. We will also need to have a plan on what systemic regimens to use for patients who receive immunotherapy in the upfront setting and then progress (i.e., can we retreat with a different combination including immunotherapy).
2. NRG-...

1. NRG-GY018
2. RUBY
3. GOG-3026

All three will end up as options for care. The FDA will see the applications for pembro and dostar soon and will make a decision on just dMMR or all comers. That’s practice impactful. The LGSOC has a good chance of compendia listing and could be used in practice but it also serves as the benchmark for planned trials.

1. Pembrolizumab and Dostarlimab presentations at late breaking on Monday. How will the treatment of 1L chemo for metastatic or recurrent endometrial change? What will the FDA allow us to use? How does the FDA judge this data?
2. The choice of clinical trials for our patient’s treatment may lead to superior outcomes than standard of care. I need to make sure that my institution's clinical trial portfolio is robust!
3. Use of immunotherapy in locally advanced cervical cancer may be best if given in a “neoadjuvant” fashion. I would like to see improvements in outcomes in this group as I think that we need to improve cure rates. I would like to see studies that investigate this further. Including the use of immunotherapy profiles to guide treatment. (...