What are your top takeaways from SGO 2024?

SGO 2024 was a great meeting with many excellent presentations. We are truly  “moving the needle together”. The following presentations are each practice changing. 

1. Duska et al., PMID 38521086: Pembrolizumab plus chemoradiotherapy for high-risk locally advanced cervical cancer: randomized, double-blind, phase 3 ENGOT-cx11/GOG-3047/KEYNOTE-A18 study

• Pembrolizumab combined with chemoradiotherapy (followed by continued pembrolizumab) provided a significant improvement in PFS (and now OS) vs chemoradiotherapy alone in patients with previously untreated, high-risk locally advanced cervical cancer.
• Observed benefit was consistent across all prespecified subgroups.
• Safety profile was manageable.
• Data support pembrolizumab + chemoradiotherapy as the new standard of care for patients with newly diagnosed, previously untreated, high-risk, locally advanced cervical cancer. 

1. Makker et al.: Efficacy and safety of trastuzumab deruxtecan in patients with HER2-expressing solid tumors: biomarker and subgroup analyses from the cervical, endometrial and ovarian cancer cohorts of the DESTINY-PanTumor02 study

• T-Dxd demonstrated clinically meaningful ORRs in heavily pretreated patients with HER2 expressing endometrial, cervical, and ovarian tumors.
• Responses were observed in patients with IHC 3+ and IHC 2+ expression with greatest responses in those with IHC 3+ tumors (central testing).
• ORR rates were: endometrial: 84.6%, cervix: 75.0%, ovarian: 63.6%.
• Responses were observed regardless of # of prior treatment regimens, use of prior HER2 or TOP1 inhibitor therapy for certain gyn cancer types.
• Responses were observed independent of biomarker status.
• Safety profile reasonable; active management monitoring is required to prevent high-grade interstitial lung disease/pneumonitis.

1. Cibula et al.: Survival of patients with early stages cervical cancer after SLN biopsy without systematic pelvic lymphadenectomy. SENTIX prospective single-arm international trial ENGOT-CX2

• The recurrence rate (at 2 years) after SLN biopsy for patients with early-stage cervical cancer was 6% and was NON-inferior to the reference rate of 7% in historical cohorts.
• Survival of patients after SLN biopsy was excellent (93.3% at 2 years), comparable to recent prospective trials.
• There was no difference in survival for patients undergoing MIS vs laparotomy surgical approach.
• Bilateral SLN identification was high = 92%.

SGO 2024 had a lot of updates of previously presented clinical trials - many of them from the ESMO conference from last year. So there were not many earth-shattering findings there.

A) A few important updates of previous studies:

RUBY study - looking at the addition of dostarlimab IO to chemo for advanced uterine cancer - showed now an overall survival benefit which was large. In the dMMR/MSI-H population, at 39.8% maturity, the HR for OS was 0.32 (95% CI 0.166–0.629). Median OS was not reached in the dostarlimab arm and was 31.4 mo in the PBO arm.

BEATcc study - looking at the addition of atezolizumab IO to bev and platinum-based chemo for stage IV cervix cancer - both PFS and interim OS were statistically significantly improved with the addition of atezolizumab to bevacizumab and chemotherapy.

GOG-258 - Molecular analysis

This retrospective analysis of GOG-258 by the 4 molecular prognostic groups showed a surprisingly different answer compared to PORTEC-3 subanalysis.
The continental divide in the management of endometrial cancer between Europe and the USA continues - there was no difference by molecular group which is counterintuitive.

The 5-year and 10-year OS rates were not significantly different for CRT compared to CT for patients with p53wt [5 yr CRT: 88% vs CT: 80%, 10 yr CRT: 76% vs CT: 71%, HR 0.67 (0.38-1.20); p53abn (5 yr CRT: 41% vs CT, 37%, 10 yr CRT: 23% vs CT: 25%, HR 0.95 (0.59-1.52); and dMMR (5 yr CRT: 73% vs CT: 81%, 10 yr CRT: 55% vs CT: 67%, HR 1.40 (0.73-2.69), EC], respectively.

We will need to wait for randomized clinical trials to give us answers on this.

B) Poverty and cervix cancer burden: Mapping behavioral and socioeconomic drivers of geographic dispersion of disease burden with the Geo-Analyzer

In this presentation by Dr. @Dr. First Last from LSU - lower income level (<200% FPL) was significantly associated with lower screening rates, as well as higher cervix cancer and recurrent/metastatic cervix cancer burden (all p<0.01). The proportion of Hispanic and Asian populations in a ZIP-3 was significantly associated with higher and lower CC burden, respectively (p<0.01 each). Comparing relative burden of r/mCC to CC, we found that the presence of ≥1 brachytherapy center in a ZIP-3 was associated with a 3% reduction (p<0.01) in r/mCC burden indicating some benefit (by association) from brachytherapy as reducing the incidence of recurrent cervix cancer.

C) Personalized ablative therapy for oligometastatic cervical cancer (OMCC): Unexplored potential

In this retrospective dataset by Dr. Walker from UTSW, the possible benefit of localized ablative therapy was studied. In this cohort of stage IVB and recurrent cervical cancer patients, nearly half (47%) of the patients met the criteria for OMCC, with the majority (62%) having 1-3 lesions. Patients with OMCC had a near significant improvement in PFS over those with polymetastatic cervix cancer. This PFS advantage of OMCC could be further augmented by the incorporation of personalized ablative therapy, such as radiotherapy into their care and needs to be studied in clinical trials.