Advancing Gynecologic Oncology Through Clinical Trials: A High-Accrual Model That Delivers Impact

Clinical trials remain essential to advancing care in gynecologic oncology — yet enrollment remains exceedingly low. In large national datasets, fewer than 0.1% of patients are enrolled in trials during first-line treatment, despite evidence that participation is associated with better outcomes, according to a large national study. This is also true for subsequent lines of therapy.

UVA Health’s gynecologic oncology team has spent years developing a comprehensive clinical research program for patients with gynecologic cancers with high accruals. The Gynecologic Oncology Group Foundation (GOG Foundation) recently recognized UVA Health as the #2 site in the U.S. for 112 total accruals to GOG Partners and NRG trials over a three-year period (1/1/23 through 12/31/2025), among participating sites nationwide — including many larger academic centers.

This research has produced meaningful improvements to standards of care while opening more options to patients.

Rather than viewing accrual as the only measure of research activity, the UVA Health team uses a set of consistent practices to integrate clinical trials into everyday patient care — with the goal of ensuring every patient has the opportunity to participate.

Offer Every Eligible Patient a Trial

A core principle of the program is simple: every eligible patient is offered a clinical trial, without provider assumptions about interest or ability to participate.

“Sometimes providers make a decision in their mind not to talk to a patient about a trial — assuming she’ll say no because she has young children, limited education, or may not trust the process,” Linda Duska, MD, Associate Dean for Clinical Research and a gynecologic oncologist at UVA Health, explains. “I take the attitude that I'm going to offer every eligible patient a trial without preconceived notions about whether they’ll say yes or no. I’ve encouraged my team to do the same.”

This approach ensures access to trials is consistent across patient populations and not influenced by unconscious bias — contributing to strong enrollment across a diverse patient population.

Build a Portfolio That Meets Every Patient Need

High accrual also depends on having the right trials available. The team strategically manages a broad and intentional clinical trial portfolio designed to reflect the full range of clinical scenarios seen in practice.

When they identify gaps, the team works to identify and open studies that address those needs. This proactive approach ensures trials are available for patients with a wide range of disease characteristics and individual circumstances.

The portfolio includes NCI sponsored cooperative group trials, early-phase studies evaluating novel targeted therapies, pharmaceutical sponsored studies, and investigator-initiated research that explores additional dimensions of patient care.

“What we really want is to have a trial for every patient,” Duska says. “We hope to make a difference in people's lives, and also to change the treatment landscape for future patients.”

Align the Entire Care Team Around Clinical Trials

Successfully integrating clinical trials into care requires alignment across the entire clinical environment — not just among investigators.

At UVA Health, this includes engagement from all members of the care team, from physicians and other APPs (NPs and PAs) and research staff to nurses, medical assistants, and front-line clinic personnel. Establishing a shared understanding of the value of clinical trials means patients receive consistent messaging and support.

This team-based model reinforces clinical trials as a standard component of care, rather than a separate or optional pathway.

Translating Access Into Impact

High clinical trial participation not only expands access for patients — it also accelerates the development of new therapies and contributes to evidence that shapes care nationally.

Driving Practice-Changing Advances

UVA Health investigators are contributing to practice-changing advances in gynecologic oncology. Most recently, research led by Duska as national principal investigator of the KEYNOTE-A18 trial demonstrated improved progression-free survival with the addition of pembrolizumab to standard chemoradiation for patients with stage III-IV cervical cancer. These findings led to FDA approval of pembrolizumab, establishing a new standard of care.

Kari Ring, MD, served as the UVA Health site principal investigator for the RAMP 201 trial, which led to a novel combination therapy for low grade serous ovarian cancer, with findings published in the Journal of Clinical Oncology.

Leigh Cantrell, MD, is acting as the UVA Health site PI for the ROCC trial, which has the potential to change the surgical management for early-stage cervical cancer in the future, while giving our current patients the opportunity to potentially have their surgery performed minimally invasively.

Expanding Access to Clinical Trials

The program’s impact extends beyond individual trials. UVA Health researchers are also contributing to broader efforts to improve clinical trial access. Ring and Duska outlined strategies to expand access to cancer prevention and clinical trials for rural and underserved populations, addressing persistent barriers that limit both participation and the generalizability of research findings. The full plan was published in Gynecologic Oncology.  

With support from the UVA Comprehensive Cancer Center, Duska completed a study comparing community member and provider-perceived barriers to clinical trial enrollment in rural areas. Kaylee Underkofler, MD, presented it as an oral plenary at the opening session of the 2025 Society of Gynecologic Oncology Annual Meeting on Women's Cancer.

These efforts reflect a model in which clinical trials are not only available but actively advancing the field — both by improving access and by generating evidence that informs care across practice settings.

A Model for Integrating Research & Care

As clinical trials continue to play a central role in advancing gynecologic oncology, programs that successfully integrate research into routine care will be critical to improving outcomes.

At UVA Health, a focus on access, intentional portfolio design, and team-wide alignment has created a sustainable model for high accrual — one that not only expands opportunities for patients, but also contributes meaningfully to the future of cancer care.