Dr Salani on the De-Escalation of Therapy in Gynecologic Oncology

Ritu Salani, MD, gynecologic oncologist, director, Gynecologic Oncology, University of California, Los Angeles (UCLA), UCLA Health, discusses the de-escalation of therapy and unmet needs within the landscape of gynecologic oncology.

Salani highlighted discussions that took place during the 2024 SGO Winter Meeting. Forexample, in the realm of gynecologic oncology, there is a notable trend toward exploring the potential benefits of minimizing therapeutic interventions, achieving comparable oncologic outcomes with de-escalated treatment strategies that may help patients avoid financial burdens and adverse effects, Salani begins. One presentation session during the meeting touched upon several areas where treatment de-escalation strategies, though not yet universally embraced, hold promise, she explains.

These areas include the consideration of immunotherapy alone for mismatch repair–deficient endometrial cancers as opposed to combining it with chemotherapy, evaluating the efficacy of chemotherapy as a standalone option, and exploring less aggressive surgical approaches, such as minimally invasive techniques for ovarian cancer, Salani elucidates. A particularly noteworthy aspect of this session was the exploration of employing less radical surgery for early-stage cervical cancer, she states. The current gynecologic oncology treatment paradigm offers an opportune moment to identify optimal ways to enhance both the quality of life and outcomes for patients and reduce detrimental effects on oncologic results, Salani emphasizes.

Another session delved into groundbreaking data that have significantly shaped the treatment paradigms for endometrial and cervical cancers, she expands. However, with the abundance of treatment choices, particularly evident in the 4 trials examining immunotherapy in endometrial cancer, challenges lie in determining the most suitable option for individual patients and establishing effective sequencing strategies, Salani states. Although it is exciting to witness the emergence of novel data and treatment options, the plethora of choices can lead to a complex decision-making process and potentially create gaps in subsequent lines of treatment, she notes.

Addressing the session's focus on clinical trial enrollment, a key concern was improving diversity in clinical trial populations and ensuring continued access to trials, especially for patients facing barriers to entry, Salani continues. These issues underscore the ongoing need for active engagement and dialogue between oncologists and patients to overcome enrollment challenges and promote inclusivity in clinical trial participation, she concludes.