Precision Medicine Heats Up Ahead of SOGO Annual Meeting in GI Cancer

As molecular testing capabilities improve and precision medicine becomes more widely utilized in the field of gastrointestinal (GI) cancers, understanding and applying multidisciplinary technologies in clinical practice is key, according to E. Gabriela Chiorean, MD, FASCO. Chiorean will cochair the 10th Annual School of Gastrointestinal Oncology® (SOGO®) meeting taking place on February 15, 2025, in Pasadena, California, where these topics and more, will be highlights.1

“Sometimes, medical oncologists themselves may not be familiar with up to date surgical and interventional procedures, or with which patients are best candidates for such interventions,” Chiorean said. “Having experts in the room who can skillfully speak to these technologies and [their] applicability to daily practice is very important. It will be educational for the entire audience.”

In an interview with OncLive®, Chiorean highlighted key topics of interest that will be discussed at the SOGO meeting.. Chiorean is clinical director of the GI Medical Oncology Program, professor in the Clinical Research Division at Fred Hutch. She is also a professor of medicine at the University of Washington and director of the Clinical Research GI Oncology Program at the University of Washington/Fred Hutch in Seattle.

OncLive: What are you looking forward to discussing with colleagues at the SOGO meeting in February?

Chiorean: SOGO is one of the most exciting conferences that I participate in each year, and I call it exciting because in one day it brings together medical and radiation oncologists, surgeons, and interventional radiologists sharing some of the most important multidisciplinary developments to date. We’re going to [discuss] multidisciplinary technologies that apply to patients with colorectal cancer [CRC] and liver metastases such as liver transplant, hepatic arterial infusion therapies and histotripsy, in addition to a multitude of novel precision oncology agents such as KRAS and PRMT5 inhibitors, and immunotherapies beyond PD-1 and CTLA-4 blockade as they apply across a wide spectrum of GI cancers.

What sessions are you looking forward to at SOGO?

The session on novel technologies for patients with CRC is a very exciting one because we will have several surgeons who are nationally and internationally renowned talk about a variety of technologies [regarding] how to treat [patients with] liver metastases which may enable some patients to be cured or live long lives with cancer as a chronic illness kept in check. [Patients with] liver metastases from CRC are some of the most difficult and most complex to treat. These interventions are experience and technology dependent and may not be available in every institution. Spreading the knowledge on up to date technologies and how to approach liver metastases from a multidisciplinary perspective is important for GI oncologists.

How can evolving strategies with molecular and genomic analyses further personalize care for patients with GI cancers?

The question about implementing precision medicine comes down to identifying not just genes, but overall molecular alterations present in the cancer and in the patient’s germline. Sometimes it’s a protein expression, sometimes it’s a gene amplification or mutation, sometimes it’s an immune profile—and there are multiple tests that we can use every day, both tumor-based as well as blood-based, whereby we make decisions on targeted therapies. We will discuss both about best diagnosis tools and their corresponding clinical applications but also emerging targets being tested in clinical trials. And we are just getting started on artificial intelligence but that may be a topic for a future SOGO.

Is there any ongoing genomic research you’re involved in that you’d like to highlight?

As many of my colleagues, I am involved in molecular based research whereby we select patients for clinical trials based on tumor molecular profile. At the Fred Hutchinson Cancer Center we lead several cellular therapies-based clinical trials, and I have been particularly involved with chimeric TCR T cells targeting mesothelin in pancreatic cancer, and more recently TCR T cells targeting KRAS G12V mutations in pancreatic cancers and other solid tumors. Having said that, I believe that combination strategies of immunotherapies or even chemotherapies with targeted therapies towards key cancer drivers, likely tumor dependent are poised to be more successful than one approach alone. It is all about strategic and innovative teamwork.

Which combination therapies are exciting?

In CRC I’m excited to see the success with the combination of chemotherapy and targeted BRAF therapy encorafenib plus cetuximab for first line treatment of patients with BRAF V600E mutated tumors. Another example of successful combination chemotherapy with targeted therapy is the recent zolbetuximab-clzb [Vyloy] FDA approval in gastroesophageal cancers, where we combine chemotherapy with zolbetuximab, an antibody targeting CLDN18.2, to prolong survival.

I’m also very excited to see many clinical trials building upon the success of KRAS-targeted therapies, which as monotherapy induce response rates around 20% to 30%, and we will be combining these agents with chemotherapy and other targeted therapies for what we hope will be the best and durable efficacy.

What other targeted agents are important to note in the GI space?

I’m very excited about the recent FDA approval for zenocutuzumab-zbco [Bizengri], which is a HER2/HER3-targeted bispecific antibody, which can [treat] patients with pancreatic cancers and non–small cell lung cancers that express NRG1 fusions. NRG1 fusions are enriched in patients with KRAS wild-type pancreatic cancers, and we think that the efficacy of zenocutuzumab, which [yielded] a 40% response rate and very durable responses, is a huge asset to the pancreatic cancer armamentarium. Granted, it’s a very rare molecular alteration occurring in less than 1% of our patient with pancreatic cancer. Nonetheless, it’s worth looking for with RNA-based NGS tumor or blood testing, and patients whose tumors express this fusion have the opportunity to be treated and derive very meaningful benefit from this new FDA approved medication, zenocutuzumab.

Reference

1. 10th Annual School of Gastrointestinal Oncology (SOGO). Physicians’ Education Resource, LLC. Accessed January 15, 2025. https://www.gotoper.com/courses/school-of-gastrointestinal-oncology