Emerging Strategies and NGS Testing in Ovarian Cancer

In an interview during 2026 SGO Annual Meeting, Alison Schram, MD, discussed the broader implications of emerging therapies targeting tumor suppressor mutations, highlighting a potential paradigm shift in oncology drug development and how these advances could reshape treatment strategies across gynecologic cancers.

Schram emphasized that the investigational agent rezatapopt represents a truly first-in-class approach, not only for p53 Y220C mutations, but also as an important proof of concept for reactivating tumor suppressor proteins more broadly. She noted that oncology has historically focused on targeting oncogenes—mutations that drive cancer growth and are often more “druggable.” In contrast, tumor suppressor genes have long been considered largely “undruggable,” leaving a vast and largely untapped landscape of mutations and proteins. The ability to pharmacologically restore or reactivate these pathways, she explained, introduces a fundamentally new strategy in cancer therapeutics. If successful, this approach could significantly expand the range of actionable targets beyond traditional oncogene-driven models and open the door to treating cancers that previously lacked targeted options.

She also highlighted the importance of early and comprehensive molecular testing in clinical practice. Because many patients with ovarian cancer are diagnosed at advanced stages—often stage III or IV—Schram stressed that next-generation sequencing (NGS) should be performed at the time of diagnosis rather than delayed until later lines of therapy. Early genomic profiling, she explained, can help identify actionable mutations that may not be immediately relevant to frontline treatment but become critical in guiding subsequent therapeutic decisions as disease progresses.

Although the clinical trial discussed was not conducted in the frontline setting, Schram noted that early identification of mutations can still meaningfully inform long-term care planning. This includes helping clinicians anticipate later-line treatment options and informing maintenance strategies. She specifically highlighted that identifying alterations such as somatic BRCA mutations can be essential for selecting patients who may benefit from targeted therapies.

Overall, Schram emphasized that the combination of novel drug development strategies and routine molecular testing reflects an evolving precision oncology landscape—one in which deeper genomic understanding and innovative mechanisms of action work together to expand treatment possibilities for patients with advanced disease.