Report Back from SGO: What’s New in Uterine Cancer?

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Unknown
Hello, everyone. We'll get started in just under a minute. Okay. Well, I'm going to get started. Hello and welcome to today's webinar report. Back from GEO. What's New in Uterine cancer? I'm Kitty Silverman, the uterine cancer program Director Chair. Today's webinar will focus on any new information and research advances that came out of the Society of Gynecologic Oncology Annual meeting held last month.

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Unknown
Before the presentation begins, I'd like to tell you a little bit about share. Share is a national nonprofit that supports, educates and empowers anyone who has been diagnosed with breast or gynecologic cancers and provides outreach to the general public about signs and symptoms because no one should have to face breast, ovarian, uterine, cervical or metastatic breast cancer alone.

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Unknown
For more information about upcoming webinars, support groups and our helplines, please visit our website at Share Cancer Support dot org. All participants will be muted during the presentation. Once Dr. Haskins finishes presenting, we'll begin the Q&A discussion. Feel free to ask any questions through the Q&A section at the bottom of your screen. Remember that Dr. Haskins is unable to give specific medical advice, so please keep your questions general in nature.

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Unknown
We also have closed captioning available. You can enable this feature by clicking the live transcript button at the bottom of the screen and selecting the subtitle option. The webinar is being recorded and will be available on the share website soon. We're very excited to have Dr. Ebony Haskins joining us today. Speaker And now I'd like to hand it over to Dr. Haskins to introduce herself.

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Unknown
Good afternoon. Okay. I will introduce myself. I am a gynecologic oncologist. Yes, that's me. Probably five years ago when I had more hair, but I've since. Cut it off. It's the same person, though. I am a gynecologic oncologist at in Washington, D.C., at MedStar Washington Hospital Center. I've been in practice for 13 years. I'm originally from Michigan and have been in the area in the Washington, D.C. area, approximately ten years.

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Unknown
I'm pretty much a clinician and meaning 100% clinician, and we are working on improving clinical trials available at our institution. Outside of work, I have one child and husband and we'll talk about that. Well, I guess one husband. Yes. We'll talk about that later. So I think I can share my screen now.

00:03:13:19 - 00:03:38:12
Unknown
So I will have to tell everyone that it's on. I wish I could see you. I wish I could talk to you. But what my hope is, is that we can get through the slides I have here to share. And I know that they're not kind of the most user friendly. So I would suggest that if you have any questions or think this popped up and you're like, Hey, I don't quite understand what that means, please shut it down.

00:03:38:12 - 00:03:59:12
Unknown
And I'm happy to go back over it if you have any questions in the chat via Katie. So certainly I miss hearing your voice, but I think any written voice would be great. So I'm here to report back from ASCO what's new in uterine cancer and SDOH who those who do or do not know is a society of gynecologic oncologists.

00:03:59:14 - 00:04:30:05
Unknown
It I think we have about 1300 members. It includes gynecologic oncologists, medical oncologists, physician, assistant, MDS, radiation oncologist, kind of the whole slew of folks that take care of women with GYN cancers. So my objective today so we can go through it will be really kind of what's on the horizon for treatment. And when we talk about what's on the horizon, meaning what's coming out, phase three and I'll go through a little bit, detail what that means.

00:04:30:10 - 00:04:59:13
Unknown
Phase two data, kind of what's in the pre development, meaning not inpatients yet and then kind of some some things that assess providers are kind of working through, which is the staging that's new. So first step you're ready for the complexity. I'll try my best. So, Ruby, one for those who know or may not know, was a clinical trial that had resulted data studio and 2023.

00:04:59:18 - 00:05:28:07
Unknown
It is a phase three. So I'm going to stop here. Phase three means it is a trial that has gone so far along in development. It's looking to see if the standard of care can be improved upon with the new drug. So prior to this trial, standard of care for advanced or recurrent enemy jaw cancer who've not had chemotherapy before was use of chemotherapy, carboplatin paclitaxel, and then phase three is same.

00:05:28:07 - 00:06:14:04
Unknown
Is there anything else that we can improve upon to have improved survival? So this is looking at carboplatin paclitaxel and are still a mab, which is a type of immunotherapy versus carboplatin paclitaxel and placebo. So essentially standard arm. And this trial went on for six cycles of those treatments. Patients were randomized, meaning they could either get the experimental arm versus the placebo arm, and then they went on to either continue with their still IMAP or placebo up to three years and the take home point is that we looked at different markers in the tumor of the cancer to see if it's so what we call MMR proficient or deficient.

00:06:14:04 - 00:06:36:22
Unknown
So kind of in patients we know that patients who have a deficiency in these proteins actually did even better with are still AMAT and patients who did not have a deficiency in the protein. Protein still did better as well. We always think about the side effect profile when we're adding new drugs and we felt like they they're pretty safe.

00:06:36:23 - 00:07:03:00
Unknown
Fatigue, hair loss, anemia is probably one of the bigger ones. And peripheral neuropathy as well as nausea. And they're in both arms. So picture confusing. But the whole take home point in this slide is that that there was an improvement in what we call overall survival when they looked at all the patients, whether they had different protein markers on the tumor or not.

00:07:03:04 - 00:07:30:23
Unknown
And so the line that we're looking at is this purple line showing that in all patients use of carboplatin paclitaxel and are still amat had a or an improvement in survival up to in this duration of the responses up to 37.2 months. Sorry where's my and this is breaking it down this is data that is breaking it down.

00:07:30:23 - 00:08:06:03
Unknown
Remember we talked about deficient MMR and how the they're still a MAB. The immunotherapy had an even greater response in this patient population. So now what I'm saying is if I have a patient who has a tumor that either has a what they call microsatellite instability or lynch syndrome, or some of these tumor markers that are not present in the tumor, I'm now treating with carboplatin paclitaxel and are still a mab and then allow offering a maintenance therapy meaning after the chemotherapy part is complete.

00:08:06:05 - 00:08:42:17
Unknown
Giving this are still a MAB treatment every six weeks up to three years because they improve survival benefit. So what about the patients who have tumors that are proficient in MMR? Still an improvement. It's not as high as the tumors with without the deficiency, but it shows less. I mean, I'm sorry, still overall improvement in overall survival. So that's Ruby one.

00:08:42:19 - 00:09:16:21
Unknown
Now, the second trial, which is very similar, this one is called NRG gy0 18. And the the main difference between this trial and the trial just spoke about is the previous trial included tumors such as carcinoma sarcoma, which can be a rare but yet aggressive histologic type of intimate oral cancer. So phase three similar thing where I explain before phase three carboplatin paclitaxel, except this time it's pembrolizumab and barzola mab.

00:09:16:23 - 00:09:44:16
Unknown
You may hear it on TV as KEYTRUDA, that's that drug versus again carboplatin paclitaxel and placebo. And it's very similar again in terms of how it's administered. But the inclusion criteria in terms of the histology is a little bit different. But again, these these data are still maturing, but their overall and progression free survival showed an improvement and increase.

00:09:44:18 - 00:10:12:03
Unknown
So again, this is breaking it down. I'll move this showing improve sort of progression free survival and here they're looking at to see where the the tumor had a marker on it a PD L one so ready for the science from Brazil the MAB blocks PD one which blocks PD-L1. So long story short, it really didn't matter whether the tumor had the marker or not.

00:10:12:03 - 00:10:44:23
Unknown
They showed improvement. That's the total take home point. And when I say improvement, I mean the progression free survival. So you're like, what does that mean? Meaning how well patients do wear out having how long they went without having any increase in in the disease on imaging. So again, prove sorry. And so this is I think my slide is a little messed up, but I'm just showing here.

00:10:45:02 - 00:11:20:16
Unknown
Can Brazil improve progression free survival regardless of whether the PD-L1 marker was present in the tumor? Okay, Remember, remember I talked about the first trial being a phase three and it's part of the Ruby trial. So Ruby had something called part one and part two. And so ASCO here, they talked about part two. So the part two in this kind of goes to what I talk to you about before, but this part of the trial looked at again, same patients.

00:11:20:18 - 00:11:45:23
Unknown
Patients had stage three or stage four or advanced disease or a first recurrence. And they looked at all histology. And when they say sarcomas, they mean carcinoma. Sarcoma was not uterine sarcoma was like the traditional uterine sarcoma. And these are kind of the inclusion inclusion criteria. Now, I think my next slide, I go through it, but I'll go through it a little bit on the other end.

00:11:46:01 - 00:12:25:05
Unknown
This again looked at carboplatin, then paclitaxel with that immunotherapy. But then for maintenance they added not just the immunotherapy but a niraparib, which is actually a drug, a PARP inhibitor that we typically use in ovarian cancer. So I think what the the the clinical trial, what they're looking at to see is there an improved survival benefit by adding not only they're still a MAB but niraparib versus looking at patients that had the carboplatin paclitaxel and placebo or just placebo on placebo.

00:12:25:07 - 00:12:50:06
Unknown
And this this showed a statistically significant progression free survival with the use of they're still a map and niraparib. Now I would have to say I'm a little biased and I'm not I don't know if I, you know, thought about adding this to, you know, offering it to my patients at this point because it doesn't really show us what happens.

00:12:50:06 - 00:13:12:05
Unknown
We already they already showed us that if you have dark still a map alone there is an improvement. And I would have loved to see what it looked like without adding that PARP inhibitor because that drug can be a little bit toxic in terms of side effect profile, but they show an improvement and I'm just here to present it.

00:13:12:07 - 00:13:41:14
Unknown
Okay, So I'm just I wanted to just kind of let you guys know what's kind of coming down the pipeline is the use of looking that. Again, like I said, PARP inhibitors are drugs that are used typically in ovarian cancer, that there has been some new studies coming out, looking at it in in immature cancer. It is used just so you know, as a maintenance drug.

00:13:41:16 - 00:14:05:13
Unknown
It can inhibit cancer cells from repairing itself, which results in cell death. There's a limited study in the lack of arm, like I just said before. And then the side effect profile, probably the biggest that I've seen with use of it in patients with ovarian cancer is really it can kind of knock down the blood count, such as the hemoglobin platelets and white blood cell count.

00:14:05:15 - 00:14:34:14
Unknown
I've even seen it impact kidney function and fatigue. So, you know, before adding an additional drug, I certainly want to see that it shows a benefit. Again, these these trials are fairly early on and we need to kind of continue to follow to see, you know, mature data. So this slide is, again, just what I just mentioned, kind of what are the side effects?

00:14:34:14 - 00:15:04:17
Unknown
So these are what they call ease or adverse effects. The main way to look at it is side effects. And typically anything that's a grade three is something where the dark or we would have to like either stop the drug or hold the drug or reduce the dose. So when you see these darker, it means when they use like say, MRAP, Niraparib and they're still a MAB, it's a little bit higher anemia so much they probably even had to hold blood transfusion, etc..

00:15:04:19 - 00:15:35:11
Unknown
And that's kind of the biggest thing that I see. They say anemia, but I think that includes all kind of milo suppressive meaning, you know, bone marrow. Okay. So new drugs that are on the horizon. I have to admit I'm quite excited about these new drugs that are on the horizon. They are currently clinical trials that are enrolling.

00:15:35:17 - 00:15:56:22
Unknown
So we don't have a lot of data on the new like we have at my institution to trials that offer these antibody drug conjugates and so the amount of, you know, phase two data is still occurring these patients into it, but this is early. So let me just give you a background. What it is, is call these are a new class of drugs.

00:15:56:22 - 00:16:27:13
Unknown
So when we say chemotherapy, we mean drugs that are toxic to cells that kill not just only cancer cells, but they also can kill normal cells. Killing the normal cells is what causes side effects like anemia, hair loss. You know, Giedd said Those are things and they're kind of non specific. Where is an antibody drug conjugate? The goal is to be more specific in target cells or antibodies or a protein, if you will, that are specific for cancer.

00:16:27:13 - 00:16:58:07
Unknown
So antibody drug conjugate, they typically have a monoclonal antibody towards a specific target on a cancer cell. So that's the antibody. And then there's attached to a drug and what they call a linker there are new that are on the horizon. And our reason we like it is that it can target a cancer cell and antigen while not harming healthy cells or having less harm to healthy cells that there is a strong drug conjugate and high toxicity to cancer to an actual cancer cell.

00:16:58:12 - 00:17:23:16
Unknown
And it can go inside the cell and kill inside the cell and that it is a stable linker. So remember, we're going to antibody drug content that can release into the cells and then that it can focus on specific cancer cells and reduce side effects. So the one that was presented at the Society of Gynecological Colleghi is actually currently FDA approved in breast cancer.

00:17:23:16 - 00:17:51:21
Unknown
So there's been use in the drug already. It's not a novel drug at this point, but novel in the gang cancer world. And they, as the name of this study is called Destiny Pan Tumor two and it looked at endometrial cancer, ovarian cancer and cervical cancer that express her to. And in this particular trial, the tumors had to have her two plus two or her two plus three.

00:17:51:23 - 00:18:16:08
Unknown
And I'll be honest, it was very exciting to me because they demonstrated a response in all endometrial cervical and ovarian. But in this talk, we're going to emphasize the uterine. So they demonstrated an overall survival in all patients. But you can see here, the way we're going to look at this is all patients. The response rate was 57.5%.

00:18:16:13 - 00:18:50:15
Unknown
I would say the average kind of second line treatment, if you will, for a uterine or endometrial cancer particularly is like 30%. I think pembrolizumab Verma is like 40%. So now we're like actually making headway, in my opinion. We're having an improvement in disease response. And you can see the patients that are the two patients with tumors with immunohistochemistry, that's plus three had an even better response with 84.6%.

00:18:50:17 - 00:19:24:06
Unknown
Those that had plus two had a 47.3 less than in. Just interesting. I can't explain it, but if it was more than two prior regimens, then the response to this drug was even better. And just for information purposes, even the response rate in these HER2 positive cervical cancer and ovarian cancer were again great, even best in uterine. So this is certainly a drug, I believe it is currently on the National Cancer Comprehensive Cancer Network guidelines, but it's not necessarily FDA approved in endometrial cancer.

00:19:24:12 - 00:19:57:21
Unknown
So, you know, some providers try to get it approved through the insurance and see if they can go that route to use it. I think certainly exciting in my opinion. And then we obviously, any time we introduce a drug, we have to look at side effect profile. So one of the again, looking at the darker line is gray three typically gray three is again is going to cause us to either hold the drug or dose reduce.

00:19:57:23 - 00:20:35:01
Unknown
And most likely not necessarily discontinue. And obviously we have to kind of take it on a case by case basis. But neutropenia seemed to affect about 20% of patients anemia is, I should say, severe neutropenia, but the highest was nausea and fatigue. Diarrhea with the ADCs or two antibody drug conjugates, there is increased risk of pneumonitis, which is kind of a autoimmune response to the lungs and can result in shortness of breath and other other side effects.

00:20:35:05 - 00:21:00:02
Unknown
And it is taken very seriously because any time you see a grade five, that means a patient died. And so even though the number may be low, we obviously have to always kind of keep an eye out and look very closely at patients and how well they tolerate the drug. And obviously, we want to be safe and have a good quality of life.

00:21:00:04 - 00:21:02:14
Unknown
Okay.

00:21:02:16 - 00:21:35:19
Unknown
So new drugs on the horizon, I thought this is interesting. So I'm sure you have heard of the newer drugs GLP one inhibitor. I'll click on it next. Would you be like your OZEMPIC? And they've caused some weight loss. So this is one of the drugs to zip tied. And the whole point, this is a G.D. GLP one glycogen like peptide one and inhibitor as well as a gastric inhibitory peptide receptor agonist.

00:21:35:20 - 00:22:04:15
Unknown
Long story, it's going to improve. It says insulin secretion and glycogen secretion decreased gastric emptying appetite. So these drugs that's new on the horizon is going to basically treat obesity. And as you may or may not know, endometrial cancer is linked with obesity approximately 65 to 70% of the time. So this is pre clinical data, meaning it hasn't been done in humans, but this is done in mice.

00:22:04:16 - 00:22:34:19
Unknown
And so their model is they had a mice model that had some were lean and some were obese. And then they use the injection of these drugs and they sacrifice and they they also the mice, these mice have a endometrial cancer model and they basically treated with the drug and looked at it. And they found that the mice that had this tattoos, the thirties peptide treatment resulted in less weight overall and less tumor weight.

00:22:34:21 - 00:23:03:10
Unknown
They also looked at the tumor itself and saw a decrease proliferation. That means growth, if you will, of cancer cells in the mice tumors. And when we say grow apoptosis, it means cell death, meaning like the self cell death. So it is pro apoptosis, meaning increase markers. Know that when they treat it with this treatment results suggestive that this may be an innovative strategy and treatment of obesity related intermittent cancer.

00:23:03:10 - 00:23:33:16
Unknown
So again, it is not out on the market, if you will, but it's preclinical and just kind of treatments that are on the horizon. So what else is new? Well, you want to be more complicated. Okay. So this is complicated. It's a been complicated for you because this certainly is complicated for me for many years, we have memorized, if you will, what endometrial cancer staging is.

00:23:33:16 - 00:24:08:16
Unknown
And the way I always thought about it was stage one disease confined to the uterus. Stage two, several involvement. Stage three, you can have involvement of the vagina via neck, so meaning the ovaries and fallopian tubes and or lymph nodes. And then stage four can be extension from the bower bladder and stage four B sorry for A is bound bladder and stage four B would be distant metastases, meaning spread to the liver or her lungs or somewhere out outside of kind of the pelvis.

00:24:08:18 - 00:24:46:09
Unknown
Now, in 2023, the Figo cycle means the Federation of International Gynecologic Oncologists change the staging. And I think the point and change in the staging was to take into account not just the an event anatomy, but the actual histology in terms of prognosis. And listen, it's no longer based off of the location. I mean, location. Yes. But now we take into account excuse me, the histology in terms of leg stage.

00:24:46:14 - 00:25:19:12
Unknown
So just I know these are really small letters, but just for you to look at, stage one is again confined to the uterus. But if it's a more aggressive subtype, even though it was like confined to the uterus and not invading, it can be automatically upstage. If it were, say, a serious carcinoma or a carcinoma sarcoma. And then now what we're doing now is more molecular testing of the tumors, meaning we're looking to see if there are any genetic changes or protein changes.

00:25:19:16 - 00:25:47:19
Unknown
And that will help us with sometimes treatment and sometimes prognosis. And the take home point from the SDO is that, yes, we have a new staging by if I go, but I would have to say the overwhelming majority of the participants who were of us or did like there were international participants there at the conference. But I would say most docs have not transitioned to this new staging.

00:25:47:22 - 00:26:12:17
Unknown
So there was a lot of debate about when we would change. Does that impact treatment plan? You know, kind of what do we do with it? And I think that's the take home point is that I still stage after 2009 staging, keeping in mind the 2023 staging. And I don't know when we will fully adapt, but it's certainly something to be aware of.

00:26:12:19 - 00:26:47:17
Unknown
Okay. And this kind of goes through a comparison, just to give you an example, the syllabus, I'm just going to move some stuff around. Yeah, it just is confined to the uterus, uterine corpus, now defined by the combination of the histologic type. Invasion absent or focal LV assay. So I would say when we're when we're seeing the final pathologies after surgery, we do need to pull out kind of our books, if you will, and stage.

00:26:47:19 - 00:27:16:06
Unknown
And again, I have not fully adapted the final 2023, however aware of it more from an academic standpoint. And then we're going to talk briefly about diversity in clinical trials. And then I would like to open it up. I think I'm probably ending a little bit early, but I certainly want to kind of get into a discussion, like I said earlier.

00:27:16:08 - 00:27:54:08
Unknown
So I thought this was interesting. This is diversity in clinical trials. But one of the participants at the SGA presented this data just showing breast versus gynecology to cancer survivors. And it's certainly a different number. And I think when you see a different number, the the amount of funding is different and maybe that makes sense. But I think from in the breast cancer world, there's been significant amounts of improvement in and treatment options and survival, whereas in grand World, we're a little behind.

00:27:54:08 - 00:28:26:19
Unknown
And when you see this next slide, you'll see why. So breast cancer survivorship predominates grant funding. And I think when we say grant funding, we talking about us like NIH funding, big grants, 148 versus 11, so 11 grants, higher total cost per study and survival for breast cancer versus gynecologic cancer. And one of the unmet needs that they said was gynecologic cancer survivorship, survivorship research and support.

00:28:26:21 - 00:29:07:01
Unknown
And then I definitely think that this is a good time to talk about, you know, clinical trials. Me personally, I survey underserved population in the Washington, D.C. metro area. We certainly see lots of women with advanced in a metro cancer or a like early the metro cancer, but higher histologic grade and find that and so I know that their marginalized patients have higher cancer incidence and mortality rate and unfortunately are underrepresented in clinical trials and we always say why Well, why do you want to do a clinical trial?

00:29:07:01 - 00:29:30:15
Unknown
One, this is how we know what is improving survival rate. So I just showed you data to support while why we are using immunotherapy. Had we not had participants in that trial, we would not know and have improved survival. So this is the way I look at it and at least should offer it to my patients and at least offer it there.

00:29:30:20 - 00:29:55:16
Unknown
So and as we've done this, these are not my slides, but I've done my own and like that. They say only 9% of patients are actually informed of the clinical trial. And I would have to admit I was guilty of not offering. And I think the reason why was, well, I didn't have it, so I offer it. But I also think that this is opportunities that sometimes I may not be able to offer, but it doesn't mean my patient doesn't deserve it.

00:29:55:16 - 00:30:26:14
Unknown
So listen, be informed, ask questions, inquire about trials, and then up to two thirds are willing to enroll trials, but they're just never offered, including black patients. And there are some structural barriers for lack of participation. And then these are things that we why they're important the improves the regular and improves generalizability. It's an opportunity to to get standard of care and cutting edge treatment and then innovation.

00:30:26:14 - 00:30:51:22
Unknown
And then I would have to say that a lot of the trials, especially the phase twos, are actually funded by the sponsor. So in terms of cost, it may be something to think about. Okay, that's the end of my slides. I would love to open up for questions. Katie And we go from there. I'm going to write a poem in case we have some hard ones.

00:30:52:00 - 00:31:18:06
Unknown
okay. Absolutely. Thank you so much, Dr. Hoskins. That was done in such an understandable way. It was really great. Thank you. Yeah, I'm going to just we're going to start the Q&A. There were a lot of we submitted questions and you can still submit through the Q&A, which is at the bottom of your screen. And we'll try to get through as many questions as we can in our remaining time.

00:31:18:06 - 00:31:45:00
Unknown
Just one quick thing to know. We're focusing today is Q&A on research updates and new developments in uterine cancer. And we did have a number of pre submitted questions related to surveillance, specific treatments and things of that nature. So I just wanted to refer everyone to a great recent webinar we had several weeks ago about moving forward after uterine cancer, about surveillance strategies, testing, recurrence, etc., which covered a lot of those questions.

00:31:45:00 - 00:32:10:20
Unknown
So you can access that video through our video library and we'll put the with the link in there. So now I'd like to start the Q&A. Dr. Hoskins. I thought this was a great question that some of these were submitted. What is the best approach to treatment planning that allows the patient to take advantage of the latest research is needed?

00:32:10:22 - 00:32:31:16
Unknown
So what was the you said, what was part of the treatment planning? Yeah. What is the for the patient? What is the best approach to treatment planning that allows the patient to take advantage of the latest research is needed? I think that's what I what I hear initially you in that question is being an advocate for yourself. That's the first thing I hear.

00:32:31:21 - 00:33:00:12
Unknown
And so I would say your doctor may not be one that's thinking about a clinical trial. And I think it's an opportunity, if it's something that you want to participate in, ask and ask upfront and not just ask, but make them make them find the trials for you. But I think it's, you know, bringing it up front, like, hey, I'm interested in a clinical trial as a potential and it may not be the right time, if you will.

00:33:00:12 - 00:33:25:13
Unknown
Maybe it's not opportunity. It depends on kind of the stage of the whole clinical scenario. But I think bringing it up is the key. That makes a lot of sense. Thank you. Now these questions, a couple of live ones. I'll switch to somebody asked and I asked you covered, I think, those first three trials so I may get the name wrong.

00:33:25:15 - 00:34:02:10
Unknown
The one that did not have the patients with parts of notes like coma. Would they ever rerun the trial for for patients with carcinoma. So coma I, I my guess is no you know it looks like these trials when they come out, they're literally like five years ago in terms of when they were development, I would guess now I think we're going to have to follow that are still a MAB trial in terms of in terms of inclusion with immunotherapy.

00:34:02:10 - 00:34:24:18
Unknown
Now, some of the trials that are going forward now are taking all types. So I would say going forward because just just as a little background carcinoma sarcoma, maybe in the last five or ten years was thought, it was thought to be a sarcoma, so not listed as an endometrial cancer. So now it's gone back to being listed.

00:34:24:18 - 00:34:52:00
Unknown
And so I don't know if that is a factor on why they exclude it, but I would say at least two trials that we have open now are all comers. Endometrial cancer, whether it was carcinoma, sarcoma or not. Thank you. From a patient perspective, at what point would you be looking at a trial post Frontline? But any day or at recurrence, what would be the point that that makes the most sense?

00:34:52:02 - 00:35:19:06
Unknown
Well, I think, you know, right now I don't think there's many there's any kind of front line. But asking about front line in our G 18 and Ruby one I'm sorry Ruby part one were front line clinical trials. There is one other one that's actually open now in Argo 26. So there's different trials. I think you can ask upfront a lot of the upfront trials actually include maintenance.

00:35:19:06 - 00:35:45:23
Unknown
So I don't I would say asking upfront before starting chemotherapy or at a recurrence, that's when I was strongly encouraged to ask about trials upfront and then they can look up and see if there's anything open because what may be open today or closed today, maybe new ones open tomorrow, and I don't know all of them, but in case you guys don't know, clinicaltrials.gov is I think it's based out of New age.

00:35:46:02 - 00:36:22:21
Unknown
And you can search what trials are available based off a tumor type. And thank you. I'm so glad you talked about the Figo, because I know that's been something that people are extremely interested in. And I have a couple of questions here related to that. How do you think the updated Figo score, if that if that's the right word, will impact health plans, coverage of gynecologic cancer, especially for immunotherapy, I think is to be determined.

00:36:22:22 - 00:36:44:11
Unknown
That's what I would say, because even now, again, the adoption of it, even though that's our that's we follow Figo, the Figo staging, it hasn't really been readily adopted. And I don't know if they'll go back and change it. Quite honestly. I don't know where we are with that, but I would say, no, not at this point. Okay.

00:36:44:13 - 00:37:11:02
Unknown
And if if one was staged initially, she changed the stage. Yeah, no, we don't change. But I did, you know, I did a talk in January and it was just very interesting because I mean, just looking at a page, one of my patients, she spoke there and I looked at her stage compared to her stage one, I think we use a to the 29 versus the 2023.

00:37:11:08 - 00:37:34:09
Unknown
She would have gotten in my opinion stage and I would have treated her differently. But we can't go back because that's not we didn't know that. Right. What we know different now is that P 53 mutation has is a is kind of a more aggressive subtype of if I go, you know, so it's hard to kind of go back and be like, I'm going to restage her because now she's since recurred.

00:37:34:12 - 00:37:54:08
Unknown
But we didn't know that, right? So I think, you know, we're going to be there. I think we're going to be there because now I look at it and I'm like, well, if I would have known that, maybe I would have treated different. I can't tell you what the outcome would have been, but I'm sure. Okay, Thank you.

00:37:54:10 - 00:38:26:04
Unknown
Was there anything presented at SGA about new uterine cancer bed basket trials? new uterine cancer basket trials? I mean, I think there we didn't nothing presented. There's things on the horizon now. okay. Okay, here's one now that's like. my gosh. So, just so you know, there is a trial that's open. It's called after 50 and it is a biomarker trial.

00:38:26:06 - 00:38:59:10
Unknown
And it basically is looking at each tumor and kind of assigning to based off of the tumor and the proteins that are present. And they assign the cohort based off of the tumor. And then there's like so that's that's one that's kind of ongoing. We don't have any data yet. Okay, Thank you. I had a number. Please submit a questions about some of the rarer, more aggressive types of uterine cancer carcinoma.

00:38:59:10 - 00:39:31:01
Unknown
So coma, clear cell also serous. And I think all of those were covered in the trial in the trial data that you that you mentioned, do you do you see any new advancements in down the horizon in terms of some of those rarer, rarer cancers? I don't see any like most of them include all I don't think at least the ones that are coming down the pipeline.

00:39:31:01 - 00:39:47:19
Unknown
I see. It's not like, okay, this is only for now. And you know, the biggest thing that I would say, it's hard to accrue those because they are rare. So I think most are going to kind of include all of them and do some analysis. You know, like the Ruby trial only included like a 10%. And I don't know.

00:39:47:22 - 00:40:18:09
Unknown
I don't know why they capped it 10%. I can't tell you why, but I think it would be hard to accrue a trial on rare tumors. Right? Right. Like a long time to occur. Sure, sure. Okay. Thank you. Now, this I think and please correct me if I'm wrong, is a question that's related to that new that medication you were talking about that I'm not sure I can pronounce that turns towards peptide.

00:40:18:11 - 00:40:44:10
Unknown
Yes. This person asked before seeing your presentation. This was pre submitted. Is anyone using or testing metformin for uterine cancers at and I think that's in the same is that the same type. they're different different class I but I don't know that offhand. I mean they may be I just don't know they definitely didn't present it there but.

00:40:44:12 - 00:41:18:09
Unknown
okay. Yeah I don't know that. Okay thank you. But that was very interesting what you were presenting about about the other. I bet it was exciting. I'm like, Well, that's kind of cool, you know? Yeah, yeah, that's great. It's really great. Okay, I'm going to go back to some more live questions. Can any of these drugs I think they must be talking about some of the the new ones you might give or maybe they're talk about immunotherapy.

00:41:18:09 - 00:41:54:05
Unknown
All right, I got it. Just throw them out. Can they be taken while using Herceptin? You know, so we always go back to our trials and say, okay, are there I don't see any of the trials. They they the ones with Herceptin are carboplatin paclitaxel Herceptin and then Herceptin in maintenance. But I don't see them in conjunction with her stepped in and immunotherapy and I haven't seen anything presented and I don't see anything in the pipeline and I don't I'm sure there's a scientific reason behind that.

00:41:54:07 - 00:42:20:17
Unknown
I'll be honest. I don't know, but I know that I don't think it's anything that's ongoing. And somebody mentioned they heard there's a trial for and and her two plus olaparib is starting or started. Let me see what enhertu is because I don't know that drug offhand may be in her to if it's because there's a lot there's some enhertu.

00:42:20:19 - 00:42:54:14
Unknown
yes, I believe so. Good question. I don't have it covered and. I don't want to tell you wrong, Steph. No, they do. They I don't remember them presenting this, but it may be a trial that's ongoing. So the other question I think that person asked, can pneumonitis be prevented or is it a case you get. Yeah, I think it can't be presented prevent it, but it can be picked up and not worsened, meaning stopping the drug.

00:42:54:15 - 00:43:29:07
Unknown
Okay. And I guess this relates back to Ruby and NRG 18 does Carboplatin Paxil, Taxol does Sterling Mab. How does carbo packs hex that? Excuse me. In fact we've got paclitaxel got compare with carbo paclitaxel and pembroke. I think they're very similar and compare in terms of side effect profile or like how so we I can't answer that because that means you would have to have a trial comparing the two arms.

00:43:29:07 - 00:43:50:11
Unknown
So I would say in terms of like looking at them separately, they have very similar side effect profile. I will say they're still a MAB is not like, for example, for our institution, it's not on formulary. And I think mainly it's been well, I can just use penumbra except until most recently, except until the patients with consciousness start coma.

00:43:50:13 - 00:44:09:22
Unknown
And I wasn't entirely convinced and I don't have that data presented here. I wasn't I didn't know I was like, Well, how do we know? You know, some of the earlier data that they presented was like, how do you know that there are still a MAB is making a difference in patients with car? So Takuma and I did see some slides.

00:44:09:22 - 00:44:36:22
Unknown
They were not presented at SGA that showed that there may be a benefit we use of it. So I've asked for it to come on formulary. I don't think I can just say, you know, it's not helpful. You know, I think it may be helpful. So we're asking for it to come on formulary, but I think in terms of side effect profile, they're very similar, but it's not FDA approved in in deficient in proficient endometrial cancer.

00:44:37:00 - 00:45:02:03
Unknown
That's another limiting kind of a dilemma. It's a little little bit of a dilemma. So I'll kind of come when I say dilemma does mean it can't be done. It just means we may have to fight to get it approved. Okay. Thank you. Somebody had a a cancer where they've been treated with KEYTRUDA and then they've had their third recurrence.

00:45:02:03 - 00:45:27:09
Unknown
Is is there something after. Well you have talked about our still about so but I think their question was after KEYTRUDA what Well I think we talked about some of the things that will be down the pike. But if there's anything else you want to add to that question, where is it on the live? QUESTION So I guess this was actually a okay, sorry, say it again.

00:45:27:11 - 00:45:58:02
Unknown
I think they're just wondering, for a third recurrence of disease and the KEYTRUDA, you know, they've reached the point where the cartoon KEYTRUDA is no longer effective, then I think this is a good time to consider a trial, right? Because I think any standard treatment is going to be chemotherapy. Right? Right, exactly. Okay. No chemotherapy, meaning Doxil. And we know the efficacy of that is not great.

00:45:58:04 - 00:46:23:11
Unknown
This is the whole why I think this is why it's exciting because we have had improvement with agents to offer. Right. And so there's actually I mean, when I first became in this as an attending, there was the second line was already like, as soon as the second line failed, the first line failed. It was kind of no other options or very minimal options.

00:46:23:16 - 00:46:55:22
Unknown
So the fact that we have trials that are available and that are occurring with the ADC and other agents is. Exciting. Yes. No, that's terrific. Thank you. Somebody is asking if there's any recent research and uterine cancer in the Pike three see Pathway. There is. There's a I can't remember what trial, but there is an open trial with that pathway.

00:46:56:00 - 00:47:36:13
Unknown
okay. Wait to hear. Okay. These were some more above I guess these are great questions. I'm like, well, this this this is very educated. Yes. Yes, absolutely. Somebody actually, this is a little unrelated, but not totally. What what is the current use of pelvic washings in treatment recommendations? Recommendations is using hyaluronic acid contraindicated indicated in cancer Washings is not part of the staging, but strongly encourage.

00:47:36:19 - 00:48:09:09
Unknown
It's more of a prognostic factor. So I collect them. But what I find is when I do see a positive washing, usually that correlates with disease being outside the uterus already. So yeah, it's more prognostic but doesn't change the staging. And I think there was a question pre submitted which I found very interesting about are there any also a little a little bit off topic but we'll we'll go there for a minute.

00:48:09:09 - 00:48:34:17
Unknown
Are there any recommended screenings for uterine cancer for breast cancer survivors other than routine gynecologic exams? If you if you if you know, you know, I mean, I guess you mean if a breast cancer survivor is taking Tamoxifen? Yeah, that's probably right. I think, you know, it's funny because you can do a transvaginal ultrasounds, but the transvaginal ultrasound can show it.

00:48:34:17 - 00:49:18:01
Unknown
They can lining in that can be just associated with use of tox, tamoxifen. So certainly being attuned to like abnormal uterine bleeding and obviously having the pelvic exam, there's no screening per say. Okay. And we talked about that. Okay. Let me just see what we just go back to some of these in one second. So and we talked about rare cancers and okay.

00:49:18:03 - 00:49:49:09
Unknown
Did the results presented at the meeting clarify the optimal duration of maintenance immunotherapy? I think you talked about the. Yeah. That the trials are written, they're already kind of pre-written. So I think the Ruby maintenance was up to three years, whereas for NRG 18 it was 84 weeks or almost like a year and a half. So again, when we present the data, the data is not much like mature.

00:49:49:11 - 00:50:26:17
Unknown
I think they're like 30% maturity rate. So we still need to wait until we have kind of the final outcome. But it won't change because the trial, that's how the trial is written, say three years, okay. With up to years. Okay. And I think, somebody who was high risk wanted to high grade, high risk. And they just the chemo was the initial treatment.

00:50:26:19 - 00:50:53:09
Unknown
Would somebody in that situation potentially advanced to some of the treatments you were talking about or would there be a would it be after they had a recurrence or at what point would they be monitored more closely? I guess. I'm sorry, what was the first question? The first they were somebody who was diagnosed with a high grade, high risk uterine cancer.

00:50:53:11 - 00:51:28:03
Unknown
And they did they did do the chemo. Okay. And I think our wondering if they should have advanced any other treatment because there there are higher grade or should they, you know, Well, if there is a recurrence that would happen. I would say routine surveillance. Yeah. I'm at this point and, you know, routine surveillance. And if something comes up, obviously, that may be an opportunity to explore trials or, you know, different treatment, but hopefully not.

00:51:28:05 - 00:51:58:15
Unknown
Right? Absolutely. And we did cover a lot about surveillance in this in this previous webinar that I that I was referring to. And I just be interested, Dr. Hoskins, for your for your practice, Do you base that on, you know, a strict protocol or you look at it case by case, what type of surveillance is best for that particular patient?

00:51:58:17 - 00:52:32:14
Unknown
I typically so, you know, obviously when we practice medicine, we practice based off of our education experience guidelines. And so there is no strict guidelines on surveillance. But I do follow one of the Society of guidance guidance kind of recommendation for surveillance. And they look, when they say just surveillance, they look at like if I get a CAT scan every three months is there improvement in survival, or is it really just making our patients nervous and anxious and more costs?

00:52:32:19 - 00:53:05:03
Unknown
And so I typically go by, you know, continued surveillance based off of their stage and grade and risk. So a patient who's high risk, who comes off chemotherapy, I typically see them every three months after they have had systemic treatment. And that means we talk about signs and symptoms of recurrence. We do an exam. And then if there's any, I always kind of like if there's any question, I have no problem scanning, but I'm not one that offers scans every three months.

00:53:05:05 - 00:53:31:07
Unknown
That's just a and that's really kind of not just based off of my own, but just some other data that was presented through the Society of Gynecologic Oncology that show that, you know, either you have you find things that are not recurrence, you increase anxiety for patients like and I think I find, you know, and then I have some patients who really want it more often and I'm okay with doing that.

00:53:31:09 - 00:54:08:05
Unknown
But after we kind of get a or two out where the risk is less, particularly after someone's gotten, say, chemotherapy or I needed some adjuvant radiation, then I definitely do less frequently or none at all. Thank you. And this was a nice comment and question kind of all together. First to say to you from someone on today, your patients are really fortunate to have a physician who attends the SGA conference and can make informed decisions regarding the most suitable treatment or medications and for their conditions.

00:54:08:05 - 00:54:42:12
Unknown
And as someone who has been recently diagnosed, they write with a guide cancer. Should they inquire whether their doctor attends the conference and feel confident that they'll assess their particular condition and recommend the most appropriate treatment and drugs come? You can ask if they're a member. I would say that me, you know, I would stay away from whether they attended the conference or not because sometimes we can't attend every conference or or some people do it from home, but are they a member?

00:54:42:14 - 00:55:13:09
Unknown
You could ask that. And then another, I think a good question to ask is if you're recommended treatment to ask, Hey, where did you derive your plan? There are some people who derive their own plan, right? And I try to like, pull out a plan. Hey, I got this plan based off of our National Cancer Center guidelines to show that I'm giving are providing standard of care or, hey, this is a new paper that just came out, you know, when NRG or 18 came out, Hey, this just came out.

00:55:13:13 - 00:55:38:00
Unknown
This shows there's some improvement in survival and show that showing that at least the doctor is up to date on new treatment, that they're following standard guidelines. And if it's kind of they're not able to kind of back it up and that I would question and you don't have to I always put it out there. You don't have to keep going to them if you don't like the care.

00:55:38:02 - 00:56:01:07
Unknown
Right? I think some people feel like, I'm going to find the doctor. No It's your body in your life. Absolutely. Absolutely. And I know you referred to there's been a lot of progress with uterine cancer treatments in the last 3 to 4 years, and it feels like it's really going in a good direction. I think so. Right.

00:56:01:09 - 00:56:28:17
Unknown
Yeah. So I think that's very exciting. And I know I've been to a few conferences and heard how excited people are about all the new the new possibilities and treatments. So I think we are going to wrap up. Thank you so much, Dr. Haskins. This was so interesting, informative, wonderful. And we really appreciate your taking time today. And thank you to everyone who submitted questions.

00:56:28:17 - 00:57:00:17
Unknown
And please make sure to check out shares, upcoming educational programs and support groups and follow us on social media as well. And we've also included the to our video library, which I referred to earlier, where you can find recordings of all of our uterine cancer webinars. And there's some really, really great information like today's program on there. So I encourage you to to watch those and please take a moment to complete a survey.

00:57:00:17 - 00:57:25:20
Unknown
At the end of the webinar. The survey will show up in your browser when the webinar ends, and the link will also be in the follow up email. And all surveys are anonymous. And this concludes today's webinar and thank you very much for joining us and I wish everybody a wonderful weekend. Thanks everybody. Have a good weekend. Bye.