Abstract

In the era of personalized medicine, the introduction of translational studies in clinical trials has substantially increased their costs, but provides the possibility of improving the productivity of trials with a better selection of recruited patients. With the overall goal of creating a roadmap to improve translational design for future gynecological cancer trials and of defining translational goals, a main discussion was held during a brainstorming day of the Gynecologic Cancer InterGroup (GCIG) Translational Research Committee and overall conclusions are here reported. A particular emphasis was dedicated to the new frontier of the immunoprofiling of gynecological cancers. The discussion pointed out that to maximize patients’ benefit, translational studies should be integral to clinical trial design with standardization and optimization of procedures including a harmonization program of Standard Operating Procedures. Pathology-reviewed sample collection should be mandatory and ensured by dedicated funding. Biomarker validation and development should be made public and transparent to ensure rapid progresses with positive outcomes for patients. Guidelines/templates for patients’ informed consent are needed. Importantly for the public, recognized goals are to increase the involvement of advocates and to improve the reporting of translational data in a forum accessible to patients.

Highlights

  • Current practice for gynecological cancers is based on the evidence generated by clinical trials mainly designed without translational end-points

  • In the BRCA1/2 germline wild type arm, an integrated study was nested, which characterized tumors according to homologous recombination deficiency (HRD) status and allowed assessment of treatment efficacy in the HRD-positive population in terms4 of progression-free survival (PFS)

  • New clinical trial designs were developed: Basket studies: Patients are selected according to their molecular characteristics and biomarkers, regardless of the site of origin of their tumor

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Summary

Introduction

Current practice for gynecological cancers is based on the evidence generated by clinical trials mainly designed without translational end-points. Translational studies are often designed and performed after the corresponding clinical trial has been completed, with translational end-points not included in the original study design with the consequence that the collection of biological material is retrospective and not performed at study entry or at diagnosis. Guidelines and consensus on translational end-points and methodologies may improve the design of pivotal trials minimizing the impact of bias. This manuscript provides a summary of the topics discussed during the Gynecologic Cancer InterGroup (GCIG) Translational Research brainstorming day and provides an overview of the consensus process together with ongoing questions/problems that remain to be addressed

Precision Medicine in Gynecological Cancer
Biomarkers
Aims
Design description
Improvement of Biomarker Development
Immunoprofiling of Gynecological Cancers
Tumor-Infiltrating Immune Cells
Tumor-Specific Factors
Tumor Antigenicity
Reactivating the Immune System
Microenvironment and Immune Responses
Findings
Overcoming Roadblocks to Completing Translational Goals
Full Text
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