SGO Winter Meeting Spotlights Key Developments and Debates Across Gynecologic Oncology

Ritu Salani, MD

The 2024 SGO Winter Meeting is a unique, collaborative learning experience where gynecologic oncology fellows and leaders alike can engage in multidisciplinary, patient-focused discussions about the latest developments, challenges, and controversies across the full spectrum of gynecologic oncology care, according to Ritu Salani, MD.

“[Now is] a prime time to find the best ways to optimize quality of life [QOL] and outcomes for our patients without negatively impacting oncologic outcomes,” Salani said in an interview with OncLive^® regarding the meeting, during which she served as an education co-chair.

In the interview, Salani provided an overview of the variety of sessions presented at the conference, highlighting the nuances of standard treatment practices, innovative discussions of patient QOL, unanswered questions in the field of gynecologic oncology, and more.

Salani is a gynecologic oncologist, the Director of Gynecologic Oncology, and the Gynecologic Oncology Fellowship Director at the University of California, Los Angeles.

OncLive: What points were raised in the session titled “Less Is More: De-Escalation & Preventative Care”?

Salani: One of the interesting [developments] happening in gynecologic oncology and oncology across the board is that sometimes administering less therapy can have equal oncologic outcomes without financial toxicity or adverse effects. [During this session], we discussed several [disease settings] where treatment de-escalation is not ready for primetime yet but may have a [role in the future]. These include the use of immunotherapy only for mismatch repair–deficient endometrial cancers vs chemotherapy and immunotherapy or chemotherapy alone; considering less aggressive surgical options, including minimally invasive surgical approaches, for ovarian cancer; and more importantly, using less radical surgery in early-stage cervical cancer.

What have been some of the “trials and tribulations” of gynecologic oncology, as discussed in the second session of the meeting?

This was a great session where we discussed cutting-edge data. We have had paradigm-changing treatments in endometrial and cervical cancer, but sometimes we have too many choices. Four trials are examining immunotherapy in endometrial cancer, and [we need to determine] the right treatment options for these patients and the right ways to sequence these [treatments].

It’s exciting to have new data and treatment options for patients, but sometimes [these areas] can get crowded. [An influx of treatment options can also] create a needs gap in the next line of treatment. [Patients] can skip their second-line treatment because it moves to [an earlier line of] therapy. Determining strategies for optimizing treatment sequencing [is important, as is ensuring that] patients can [access these treatments]. One of the interesting topics in this session was clinical trial enrollment and how we can improve diversity and [accessibility] in clinical trials for patients who may not have ready access. This is an important topic that continues to require a high level of engagement and discussion.

What controversies within the field of gynecologic oncology were raised during the third session?

[Controversies in gynecologic oncology] is an exciting [topic of discussion], too. We always have areas with some trials or studies that have reported some benefit [with certain treatments], but there’s always a bit of hesitancy, and there’s always questioning. One of these areas includes hyperthermic intraperitoneal chemotherapy for ovarian cancer. We also discussed PARP inhibitor therapies in the recurrent setting. We also talked about the use of bowel prep for patients undergoing surgery, [as well as] using immunotherapy in the mismatch repair–proficient endometrial cancer population. These are areas we all struggle with [and that are discussed at] every tumor board. I wouldn’t say we got more clarity on [how to navigate these controversial treatment decisions], but we had a thought-provoking discussion.

What points are you hoping to see discussed at the tumor board session?

The tumor board will capitalize on clinical situations we [encounter] but may not get studies on because they’re so rare, so infrequent, or [have] conflicting data. [Tumor boards are] always a nice way to engage the [session’s] audience and see what the audience is doing [in their practice]. We have approximately 500 people [at this meeting]. [We wanted to conduct an informal] poll of what practitioners are doing.

The topics that will be discussing include controversial endometrial cancer cases where you’re not sure whether you should administer therapy [in] early-stage but higher-risk patients. [Additionally, one area] I think we all struggle with is placenta accreta spectrum [PAS]. This is a phenomenon of pregnancy, but [gynecologic oncologists] often get called in for surgical management [of PAS]. How do we streamline [treatment]? [The answer includes] logistics [rather than clinical decision-making]. How do different institutions deal with this? I’m looking forward to those discussions.

What will be the focus of the session, “It’s Getting Hot in Here”? 

This is a session focused on survivorship. [During this session], we want to focus on menopause. We induce menopause early for a lot of our patients, or patients may have menopausal symptoms, and they may not be the best candidates for hormone therapy. What are [treatment] strategies [for these patients]? [In which patients] is it safe to give hormone therapy, and in whom should we consider alternative strategies?

We’re also discussing topics such as sexual dysfunction and how to optimize [sexual health] and fertility for patients. How do we preserve fertility in patients [whose fertility] may be impacted by the treatments we offer? This is a ripe topic. [This session is] all related to fertility, menopause, and sexual health. [These are] important topics that we want to highlight [to ensure] we’re up to date for our patients.

What do you hope that trainees in gynecologic oncology glean from this meeting?

I’m one of the chairs of the SGO 2024 Winter Meeting, so it’s near and dear to my heart. [This meeting includes] fellow presentations where [fellows] get to present their clinical work. [These] are usually early [studies], but [this opportunity] gets them engaged in research.

However, the most powerful aspect of the meeting is in networking. We have a room full of 500 people, and everybody’s engaged, [including] the fellows and trainees. We have students and residents here as well who get to interact with the leaders of our field. It’s an intimate environment, and they get to see high-level data that are [digestible]. This helps them [better] interpret [the data] and understand some of the controversies and future directions [in their field]. [Attendees can also] meet people and help mentor, network, and collaborate. I’ve met some of my best friends at this meeting, so it’s always a nice experience.