Kathleen Moore, MD, MS
Kathleen Moore, MD, MS, the Virginia Kerley Cade Endowed Chair in Cancer Developmental Therapeutics and Professor of Gynecologic Oncology at the University of Oklahoma Health Sciences Center, spoke with The ASCO Post about GOG-258. According to Dr. Moore, the final results of this long-running study essentially validate what has become clinical practice, and that is to avoid irradiating the whole pelvis in locally advanced endometrial cancer. Should the study be designed today, she added, the radiotherapy approach would probably be more targeted.
“We’ve known for a long time that radiotherapy improves local control but not overall survival in endometrial cancer. Chemotherapy is what impacts the overall survival rate,” she said. “The results of a lack of survival benefit in the trial are not surprising.”
“However, the findings also do not negate the importance of radiation in some settings…. It doesn’t suggest we never irradiate these patients…. It just means we don’t need the kind of radiotherapy that was used in the study,” she explained. “There is still a role for radiation therapy, but it may be less radiation than we used to give and more focused radiation. Fortunately, with advances in technology, we are now giving radiation in a safer, more tailored way.”
Dr. Moore said the study also established the importance of systemic therapy, “establishing paclitaxel plus carboplatin as the backbone” but perhaps adding immunotherapy or targeted agents, such as trastuzumab for HER2-positive cancer, or even treating with endocrine therapy alone in some cases, to further improve outcomes in the future. “We’ll have to figure out those nuances,” she added. “That’s the direction for improving outcomes in high-risk endometrial cancer: to become more individualized.”
DISCLOSURE: Dr. Moore has served in a leadership role with GOG Partners and NRG Ovarian Committee Chair; has received honoraria from Research To Practice, Prime Oncology, Physician Education Resource, and Great Debates and Updates; has had a consulting or advisory role with AADi, Alkemeres, AstraZeneca, Blueprint Pharmacetuicals, Caris Life Sciences, Clovis Oncology, Eisai, Genentech/Roche, GSK/Tesaro, Hengrui Pharmaceutical, IMab, Immunogen, InxMed, Iovance Biotherapeutics, Merck, Mereo BioPharma, Mersana, Myriad Genetics, Novartis, Novartis/Pfizer, Onconova Therapeutics, OncXerna Therapeutics, VBL Therapeutics, and Verastem/Pharmacyclics; has received research funding from Agenus, Amgen, Artios, AstraZeneca, Bolt Biotherapeutics, Bristol-Myers Squibb, Clovis Oncology, Cyteir, Daiichi Sankyo/Lilly, Genentech, Immunocore, Immunogen, Lilly, Lilly Foundation, Merck, Novartis Pharmaceuticals UK Ltd., Novogen, PTC Therapeutics, Regeneron, Takeda, Tesaro, and Verastem; has patents, royalties, or other intellectual property with Up to Date; has received travel expenses from AstraZeneca and GSK; and has reported relationships with GOG Partners.
The long-running randomized NRG Oncology GOG-258 clinical trial failed to identify an overall survival benefit with adjuvant chemoradiotherapy vs chemotherapy alone in any subgroup of patients with locally advanced endometrial cancer. After a median follow-up of 112 months, the hazard ratio for...