The landscape of gastrointestinal cancer treatment is rapidly evolving with precision medicine approaches taking center stage, as highlighted by leading experts preparing for the upcoming 10th Annual School of Gastrointestinal Oncology® (SOGO) meeting in Pasadena, California.
E. Gabriela Chiorean, MD, FASCO, who will co-chair the February 15, 2025 meeting, emphasizes the critical importance of understanding and implementing multidisciplinary technologies in clinical practice. "Having experts in the room who can skillfully speak to these technologies and [their] applicability to daily practice is very important," notes Chiorean, who serves as clinical director of the GI Medical Oncology Program at Fred Hutch.
Advanced Technologies for Complex Cases
A major focus of the conference will be novel treatment approaches for challenging cases, particularly colorectal cancer (CRC) with liver metastases. The meeting will feature internationally renowned surgeons discussing cutting-edge interventions including liver transplantation, hepatic arterial infusion therapies, and histotripsy. These advanced techniques offer potential for both curative treatment and chronic disease management in previously difficult-to-treat patients.
Molecular Profiling and Targeted Therapies
The evolution of precision medicine in GI cancers extends beyond traditional genetic testing. "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," Chiorean explains. This comprehensive approach encompasses protein expression, gene amplification, mutations, and immune profiles, utilizing both tumor-based and blood-based testing.
Breakthrough Combinations and Novel Agents
Recent successes in combination therapies have demonstrated promising results. Notable developments include:
- The combination of chemotherapy with BRAF-targeted therapy (encorafenib plus cetuximab) for BRAF V600E-mutated colorectal cancer
- Zolbetuximab-clzb (Vyloy) combined with chemotherapy for CLDN18.2-positive gastroesophageal cancers
- Emerging KRAS-targeted therapy combinations showing potential for improved efficacy
Emerging Precision Medicine Breakthroughs
A significant advancement in the field is the recent FDA approval of zenocutuzumab-zbco (Bizengri), a HER2/HER3-targeted bispecific antibody for patients with NRG1 fusion-positive pancreatic cancers. Despite affecting less than 1% of pancreatic cancer patients, this treatment has shown remarkable efficacy with a 40% response rate and durable responses.
Future Directions
The conference will also explore cellular therapy approaches, including chimeric TCR T cells targeting mesothelin in pancreatic cancer and TCR T cells targeting KRAS G12V mutations. These innovative approaches, combined with strategic combination therapies, represent the next frontier in GI cancer treatment.
"It is all about strategic and innovative teamwork," emphasizes Chiorean, highlighting the importance of collaborative approaches in advancing treatment options for GI cancer patients.
