GI Oncology standard regimen doses remain too high for many real world patients. Retrospective and prospective trials demonstrating benefit of reduced doses or dose escalation are accumulating. #meded #gionc #crcsm #pancsm

🧬 Reduced oxaliplatin exposure | GI cancers | Meta-analysis 📚 24 studies (N=30,395) ➖ No significant survival difference ✅ G≥3 neuropathy OR 0.34 ✅ G≥3 AEs OR 0.67 💡 Less oxaliplatin may improve the therapeutic index without survival loss. 🔗 doi.org/10.1016/j.ctrv.2026.… @OncoAlert

🔥 ASCOT final 5-year analysis (JCO) Adjuvant S-1 after resection for biliary tract cancer 👥 n=440 randomised (S-1 218, observation 222), median follow-up 61.5 months 📈 5-year OS 64% with S-1 vs 52% with observation ⏱️ Median OS 8.2 vs 5.9 years - HR 0.72 (95% CI 0.55–0.95), one-sided p=.01 🧮 RFS favours S-1 less decisively: stratified HR 0.76 (0.59–0.98), unstratified 0.80 (0.62–1.03) crosses 1.00 I think we need to do better.... #GIOnc #BiliaryTractCancer pubmed.ncbi.nlm.nih.gov/4277…

Read. This. This Is the Biggest Obstacle to New Cancer Cures nytimes.com/2026/09/04/opini…

And just like that, adagrasib + cetuximab is no longer FDA approved for KRAS G12C colorectal cancer. The accelerated approval was officially withdrawn September 1 after KRYSTAL-10 failed to confirm benefit. We talked about KRYSTAL-10 when it was presented earlier this year. The phase III randomized 461 patients in 2L to adagrasib + cetuximab vs chemotherapy ± VEGF inhibition. It missed both primary endpoints: ▪️PFS: 7.5 vs 8.1 months, HR 0.89
▪️OS: 21.6 vs 21.7 months, HR 0.83 Hard to argue with a negative phase III trial. But I still like the idea of a chemo free option. Response rate was 47% vs 16%. That could matter for some patients (like those who you need just a little more shrinkage to enable crative intent therapy). KRYSTAL-10 asked whether adagrasib + cetuximab was better than chemotherapy in 2L. It wasn’t. That doesn’t mean the concept of KRAS G12C + EGFR blockade was wrong. And it doesn’t mean there aren’t patients for which this isnt valuable. Anyone celebrating this should look themselves in the mirror; this is a tool that has just been removed from our arsenal. However, the FDA did exactly what the system is designed to do; pull back if the Ph III doesnt pan out after accelerated approval. @OncoAlert @TheGutOncLab @Onco_Nexus

I find this study very interesting. Very much unlike my experience as an oncologist in the U.S. where most patients I see want systemic therapy. A very large Dutch population-based study. Among 13,756 patients with mPAC, 72% did not receive systemic therapy (ST) -- Independent predictors of no-ST included increasing age, worse WHO PS (>0–1), modified Glasgow Prognostic Score (mGPS) 1–2, Charlson Comorbidity index ≥ 2, and low socioeconomic position -- Reason for not receiving ST was mostly due to patient and family preference (39%), followed by patient factors (31%, comorbidity or impaired performance status (PS)) -- Half of patients not receiving ST had a good PS (WHO 0–1) (50%), while this was 68% when not receiving ST was based on preference. -- Median overall survival was 42 days (no-ST) versus 213 days (ST). sciencedirect.com/science/ar…

Daraxonrasib now @US_FDA ✅ based off RASolute302: Daraxonrasib vs. Chemo in 2L metastatic pancreatic cancer: - ⬆️ OS: 13.2 vs. 6.7mos (HR: 0.4) - RAS mutation present in >90% pancreatic adenocarcinoma - One of the biggest advances/news in 2026 for cancer! #OncTwitter

🎉 Our new study is now published in JCO Global Oncology! 💊🖐️ Topical Diclofenac for Prevention of Capecitabine-Induced Hand-Foot Syndrome: A Prospective Real-World Study 🔬 In this prospective, two-center real-world study of 151 patients receiving capecitabine-based therapy, we evaluated prophylactic topical diclofenac for the prevention of clinically significant hand-foot syndrome (HFS). 📊 Grade ≥2 HFS occurred in 16.9% (12/71) with topical diclofenac versus 13.8% (11/80) with active monitoring (OR 1.28; 95% CI, 0.52–3.10; P = .591). 💡 Our findings showed that prophylactic topical diclofenac did not reduce clinically significant HFS or delay its onset in routine clinical practice, adding prospective real-world evidence to this evolving area of supportive oncology. 🙏 Special thanks to our first author, Dr. Orhun Akdoğan(@drOrhunakdogan) and our mentor, Dr. Osman Sütcüoğlu(@osutcuoglu) for their leadership and guidance, and to our entire team(@uyargalip, @kbaskurtt, @yucelbirkadriye) for their valuable contributions. Grateful to be part of this collaboration! 📖 @JCOGO_ASCO | @ASCO 🔗 ascopubs.org/doi/pdf/10.1200… #JCOGlobalOncology #ASCO #Oncology #SupportiveCare #Capecitabine #HandFootSyndrome #RealWorldEvidence @KVanLoonMD @RyanNipp @thenasheffect @IshwariaMD @ASCOPres

Are you interested in knowing the outcomes of the different subgroups participating in the NETTER-2 trial of PRRT with Lu-177 DOTATATE vs. octreotide LAR? If so, wait no longer. It is available online now. In short, PRRT is effective in this population. -- PFS in G2: 29 months -- PFS in G3: 22.2 months -- PFS in pNETs: 19.4 months -- PFS in sbNETs: Not reached Response rates are quite high: -- G2: 40.4% -- G3: 48.1% -- pNETs: 51.2% -- GI/sbNETs: 33.3% More details below... thelancet.com/journals/eclin…

How does one counsel a patient with resected or still-active NET on the use of incretin mimetics such as GLP-1RA and mixed GLP1-RA/GIP1-RA (tirzepatide)? Many such patients stand to derive substantial benefit from these drugs but there have been lingering concerns about long-term safety in terms of neuroendocrine neoplasms. While preclinical studies have shown stimulatory effect on growing NET cell lines (keep in mind, they may not accurately reflect NETs in humans), no convincing evidence from post-marketing studies has been seen. I will freely admit that we do not have all the answers but thanks to @UGrewalMD for leading this project with @sonbol_bassam @HansHofland1 @IHC_guy @PoHienEar @CronaJoakim James Howe, Simron Singh, Jonathan Strosberg, Joseph Dillon and Jennifer Chan. I hope you will find this useful and it will stimulate further discussion. Disclaimer: I have no COIs regarding any of these meds. acsjournals.onlinelibrary.wi…

This study identified 23 features specific to scan-associated anxiety, highlighting its emotional, cognitive, behavioral, physical & interpersonal dimensions = Scanxiety as a distinct, time-bound experience surrounding scans & results @PsyOnc onlinelibrary.wiley.com/doi/…

Important work KRAS resistance mechanisms in Daraxonrasib.

BEACON-HCC is a MultiD treatment allocation framework for HCC reflecting contemporary practice, w explicit incorporation of SBRT & Y90 based on current evidence. It's outstanding, timely & what I plan to use in practice. 👏👏👏 @OncoAlert

And to add to @MarkYarchoan 💯 thread: here are the 9 BEACON clinical classes incorporating: tumor size, multifocality, AFP, differentiation, infiltrative morphology, degree of portal vein invasion, total liver tumor burden, M1 vs M0. Importantly VP1/2 treated dif than VP3/4.

A new publication reports a 30-day mortality of 11% among nearly 1,000 pts who underwent histotripsy for primary and metastatic liver tumors. This statistic signals a need for greater scrutiny to clarify the utility and practice patterns of this supposedly "less invasive" treatment. jamanetwork.com/journals/jam…

Blood based CRC screening may be the eventual future, but once detected are patients going to get the confirmatory colonoscopy?

Congratulations @docbraunstein @Perlmutter_CC on becoming a Fellow of @ASCO! Well deserver!

Let’s not forget that the goal is to treat patients, not platelet counts- nature.com/articles/s41571-0…

🧬 Zolbetuximab hypoalbuminemia ⏱️ Early onset (peak C1-C3) ⚠️ Grade 3: 21% 💧 Edema: 100% | 🍽️ Anorexia: 93% | 🫧 Ascites: 60% 🔄 Usually reversible ✅ Rechallenge often feasible ➖ No clear impact on efficacy 🎯 Check albumin closely first cycles 🔗 doi.org/10.1016/j.esmogo.202… @OncoAlert