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

As molecular testing capabilities improve and precision medicine becomes more complex in the field of gastrointestinal (GI) cancers, understanding multidisciplinary technologies is key, according to E. Gabriela Chiorean, MD. 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, such as exciting targeted therapy combinations in the GI space, will be highlights.1

“Many times, medical oncologists themselves may not be familiar with who the types of patients are who are eligible for individual techniques and technologies, and where to refer these patients,” Chiorean said. “Having experts in the room who can speak to these technologies and [their] applicability to daily practice in an astute way is very important. It will be educational both for the speakers and for the audience.”

In an interview with OncLive®, Chiorean highlighted key topics of interest that will be discussed at the SOGO meeting and exciting targeted therapies that have recently been granted FDA approval in the GI space. Chiorean is clinical director of the GI Medical Oncology Program, professor in the Clinical Research Division, and affiliate investigator in the Translational Science and Therapeutics Division at Fred Hutch. She is also a full 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 it brings up 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; we’ll talk about histotripsy, liver transplant and hepatic arterial infusion therapies, and a plethora of novel targeted precision oncology agents that are going to be brought to light in many sessions.

We’re also going to talk about immunotherapies and novel immunotherapies beyond PD-1 and CTLA-4 [inhibitors], KRAS inhibitors, and many novel agents such as PRMT5 inhibitors in tumors that are MTAP deleted. Especially in GI cancers, having surgeons, interventional radiologists, GI doctors and oncologists, and radiation oncologists, in the same room is a huge asset to encompass a variety of engaging [conversations on] therapeutics in these tumors.

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 known talk about a variety of technologies [regarding] how to treat [patients with] liver metastases. [Patients with] liver metastases from CRC are some of the most difficult and most complex to treat. Sometimes these technologies are very experience dependent and technology dependent and may not be available in every institution. Spreading the knowledge on the available technologies and how to approach liver metastases, when to refer a patient for hepatic arterial infusion chemotherapy, when to consider liver transplant, or when to consider a novel technology [using] focused ultrasound waves to dissolve and treat tumors in the liver—which has been FDA approved in the past year for liver metastases—is very important.

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 the correct not just genes, but alterations. Sometimes it’s a protein expression, sometimes it’s a gene amplification, sometimes it’s an immune profile—it’s more than genes and there are multiple tests that we use every day, both tumor-based as well as blood-based, whereby we make decisions in terms of targeted precision oncology [therapies]. We will discuss many of these technologies and techniques on how to test patients appropriately, and what the individual molecular tests are—genomic, proteomic, immune expression, immunohistochemistry [IHC], some that can be also based on liquid biopsies—which may be appropriate in certain subsets of patients. We will discuss many aspects on how to test, what the technologies are, as well as what to do with the information and what targeted therapies we have available for patients with molecular alterations [including those that] are FDA approved and in clinical trials.

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

Talking about genomic research is a very complex and loaded question. Day to day we all send our patients’ blood and tumor tissue for genomic testing and molecular testing. We do IHC for CLDN18.2 these days, test HER2 by IHC and FISH, and test many other alterations such as KRAS by genomic analysis. I am involved with the cellular immunotherapies that are targeting KRAS mutations. It’s a novel field, and it’s an expensive and difficult one to be generally applicable.

Having said that, we firmly believe that immunotherapies in conjunction with precision oncology can be very successful. Combinations of immunotherapies with small molecules targeting KRAS probably will end up being the most successful and potentially even bringing chemotherapy into play [will be notable]—we know that these combinations of DNA cytotoxic agents plus precision medicine [therapies] sometimes can be the most successful. Combination approaches that are rational are likely to be more successful than one approach alone.

Which combination therapies are exciting?

It’s very exciting in CRC; the combination therapies of chemotherapy with targeted BRAF therapies are something that we’re excited to see because it surely looks more exciting than targeted therapy alone or chemotherapy alone. Another example of 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, rather than use one individual approach at a time.

We hope that KRAS-targeted therapies, which currently as monotherapies induce a response rate in the 20% to 30% range, will be combined with chemotherapies in clinical trials coming up next. We know that clinical trials are ongoing, but many combinations are now based on targeted [agents] plus chemotherapy [or] targeted [agents] plus immunotherapies, so we are seeing more of this.

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

I’m very excited about the FDA approval for zenocutuzumab-zbco [Bizengri], which is a HER2/HER3-targeted bispecific antibody, that applies to 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. Nonetheless, it’s worth looking for and patients who express this fusion have a great opportunity to have access now to a new FDA approval with zenocutuzumab.

Reference

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