VIRAGE puts an IV oncolytic adenovirus into first-line metastatic pancreatic cancer, biliary tract cancer gets three practice-shaping datasets (matched targeted therapy after chemo-IO, real-world CisGem sequencing, 5-year ASCOT), and ASTRO26 delivers negative proton data in HCC alongside RFA-versus-SBRT noninferiority.
๐ Publications
๐ฆ Twitter / ๐ฆ Bluesky
Full details below โ
Intravenous hyaluronidase-expressing oncolytic adenovirus with chemotherapy in metastatic pancreatic cancer: a randomized phase 2b trial. โ Garcia-Carbonero Rocio et al., Nat Med
This randomized phase 2b trial tested two doses of IV VCN-01 with gemcitabine/nab-paclitaxel (GnP) against GnP alone as first-line therapy in metastatic pancreatic ductal adenocarcinoma. In the ITT population (n = 53 vs n = 48), median OS was 10.6 vs 8.6 months (HR 0.69, 95% CI 0.42-1.12, P = 0.196) and PFS was 5.6 vs 4.6 months (HR 0.63, P = 0.046). In the FAS population (n = 48 per group), median OS was 10.8 vs 8.6 months (HR 0.57, P = 0.055) and PFS was 7.0 vs 4.6 months (HR 0.55, P = 0.011). Duration of response was 11.2 vs 5.4 months (HR 0.22, P = 0.004), with no significant differences in ORR, DCR or CA19-9. Serious VCN-01-related events occurred in 22.6% of patients.
Clinical bottom line: VCN-01 plus gemcitabine/nab-paclitaxel does not change first-line practice today because the ITT overall survival analysis was not significant. However, the tripled duration of response and the 18-month survival separation justify the planned blinded phase 3.
Pancreatic Cancer Cachexia: Integrating Mechanistic Insights With Clinical Management. โ Huang Lyndon et al., JCO Oncol Pract
Cachexia affects over 80% of patients with pancreatic cancer and decreases treatment tolerance, quality of life and survival. It remains underdiagnosed and undertreated in oncology clinics. Emerging strategies include growth differentiation factor-15 inhibition, inflammatory pathway blockade and ghrelin receptor agonism, which have shown encouraging effects on weight, muscle preservation, appetite and functional measures.
Clinical bottom line: Screen every patient with pancreatic cancer for cachexia at diagnosis. Manage it actively with nutrition, body-composition assessment and multidisciplinary input rather than treating weight loss as an untreatable marker of advanced disease.
Palliative Care for Advanced Cancer in Medicare Advantage and Physician Networks. โ Hu Xin et al., JAMA Netw Open
This SEER-Medicare cohort included beneficiaries aged 66 years or older with distant-stage breast, colorectal, lung, pancreatic or prostate cancer diagnosed 2016-2021. Medicare Advantage enrollees had a higher 6-month cumulative incidence of palliative care than traditional Medicare enrollees (13.3% vs 9.3%; AHR 1.39). After matching on treating oncologist, there was no overall difference (AHR 1.05; P = .19). Medicare Advantage enrollees received less systemic therapy (-5.38 percentage points) and more hospice (3.42 pp), and these differences persisted after matching.
Clinical bottom line: The apparent palliative-care advantage of Medicare Advantage is largely explained by which oncologists are in network. The lower systemic therapy and higher hospice use persist even within the same oncologist, a plan-level effect GI oncologists should recognize when counseling patients with advanced colorectal or pancreatic cancer.
Longitudinal liquid biopsy and matched radiomic analysis indicated resistance mechanisms of patients with biliary tract cancer undergoing systemic treatment. โ Tesini Giulia et al., Clin Cancer Res
Plasma collected at baseline (N=39) and at progression (N=30) underwent NGS for SNVs and CNVs, paired with CT tumor-burden and radiomic analysis. Baseline MET SNVs (p=0.07) and ERBB2 CNVs (p=0.03) were associated with shorter time to progression. Patients with a rising EGFR CNV score during treatment had worse outcomes than those with a falling score (TTP 4.1 vs 9.5 months, p=0.003; OS 10.1 vs 21.6 months, p=0.02). The findings point to primary (MET SNVs/ERBB2 CNVs) and secondary (EGFR/MET CNVs) resistance to platinum-based therapy, with radiomics correlating early with molecular evolution.
Clinical bottom line: Serial ctDNA during first-line chemotherapy for biliary tract cancer can flag EGFR/MET amplification as an emerging resistance route before radiologic progression. This argues for longitudinal rather than one-off molecular profiling in this disease.
A Phase II Study of Nivolumab and Ipilimumab with Radiation Therapy in Patients with Metastatic, Microsatellite Stable Colorectal Cancer. โ Pappas Leontios et al., Clin Cancer Res
Among 30 patients with refractory MSS mCRC treated with RT plus nivolumab/ipilimumab, the confirmed ORR was 10.0%. DCR was 33.3% in unirradiated lesions and 83.3% in irradiated lesions. ORR was 25.0% in 8 patients without active liver metastases versus 4.6% in 22 patients with liver metastases. Median PFS was 2.4 months and median OS was 12.8 months. Grade 4 toxicity occurred in 10%, in all cases lymphopenia.
Clinical bottom line: Adding non-ablative radiation to ipilimumab/nivolumab does not rescue immunotherapy in refractory MSS colorectal cancer with liver metastases. The activity that exists is confined to the same liver-metastasis-free subgroup already identified with checkpoint doublets.
Immune Checkpoint Inhibitor-Based Downstaging Therapy for Hepatocellular Carcinoma. โ Ong Meiching et al., JAMA Oncol
In a retrospective matched cohort of 416 recipients transplanted for HCC initially beyond Milan criteria at 8 high-volume Chinese centers, median OS was 4.57 years with ICI-based therapy versus 2.53 years without (P < .001). Median RFS was 1.47 vs 0.89 years (P = .02), with adjusted HRs of 0.63 for OS and 0.59 for RFS. Acute rejection within 90 days was more frequent with ICI exposure (34 [16.3%] vs 17 [8.2%]; P = .01).
Clinical bottom line: For selected patients with HCC beyond Milan criteria, checkpoint-inhibitor-based downstaging before transplant is associated with substantially better post-transplant survival. Because early acute rejection doubles, the trade-off must be discussed explicitly with the transplant team.
๐ Every paper considered this week, including the ones that didnโt make it โ
How these are chosen: filtered for clinical relevance, grouped by the new development discussed, then ordered by engagement (bookmarks and reposts).
The review stages management by disease extent:
Discussed by: @DraMartinezLago, @OncBrothers, @dr_yakupergun
Sources cited: Advances in therapeutic approaches to gastric cancer (CA: A Cancer Journal for Clinicians, 2026) ยท Screening for colorectal cancer (CA: A Cancer Journal for Clinicians, 2026)
Personalized neoantigen vaccines have improved outcomes in refractory melanoma and in pilot studies including pancreatic cancer, but they have required a tumor biopsy to identify antigens. A new study shows the antigens can be obtained from a blood sample. In a separate phase 1 trial of mKRAS-VAX, 90% of participants developed a KRAS-specific immune response. The question is whether blood-based identification makes personalized vaccines feasible for pancreatic cancer patients who never get an adequate tissue biopsy.
Discussed by: @EricTopol, @GOAL_GIONC
Sources cited: Peripheral Blood as the Sole Source for Cancer Neoantigen and Reactive T-Cell Discovery (Cancer Discovery, 2026)
Pooled data showed no significant survival difference with reduced oxaliplatin exposure, alongside clearly less severe neuropathy and severe toxicity. In colorectal cancer, there was no statistically significant difference in DFS/PFS or OS, including an exploratory look at T4/N2 disease. The evidence is strongest in CRC and much more limited in other GI cancers. The take-home offered was: don't stop effective treatment, but know when to stop the oxaliplatin. The debate is whether reduced cumulative oxaliplatin should become the default in adjuvant colorectal cancer, or whether the evidence is too retrospective to apply to T4/N2 disease.
Key numbers: Grade โฅ3 neuropathy OR 0.34 ยท Grade โฅ3 AEs OR 0.67
Discussed by: @ronanhsieh, @ChandrakanthMv, @DraMartinezLago
Sources cited: Elsevier ยท Advances in therapeutic approaches to gastric cancer (CA: A Cancer Journal for Clinicians, 2026)
Gut microbiome patterns have been linked to early-onset breast and colon cancer, to adverse effects of treatment and to survival prediction. High Porphyromonas abundance in a preoperative stool sample was linked to a nearly 3x higher risk of recurrence after colorectal cancer surgery. The question is whether a preoperative stool profile is ready to sit alongside ctDNA for recurrence risk stratification in resected colorectal cancer, or remains hypothesis-generating.
Discussed by: @EricTopol, @gastroendonews
Sources cited: Cell Press
NRG-GI003 hypothesized that protons could reduce liver decompensation and improve overall survival, the primary endpoint. In this phase 3 trial, protons did not improve OS in advanced HCC; median survival numerically favored photons, while severe treatment-related toxicity was lower with protons. Protons did reduce the mean dose to the uninvolved liver. The debate is whether that dosimetric advantage translates into anything clinically meaningful in HCC.
Key numbers: mOS 26.6 vs 54.9 mo, HR 1.3 ยท Grโฅ3 TRAEs 11% vs 24%
Discussed by: @NiuSanford, @jryckman3
Sources cited: Cancer Network ยท Targeted Oncology
Wang et al. randomized 93 patients with solitary HCC โค2 cm, all suitable for either treatment, to RFA or SBRT 50 Gy/5 fx. SBRT met noninferiority for 2-year local progression-free survival. Two-year OS was ~98% in both arms, with similar acute toxicity. However, this was a small, single-center interim trial with a wide CI. The question is whether SBRT is now a first-choice ablative option for a patient fit for both, rather than the fallback when RFA is not feasible.
Key numbers: 2-yr LPFS SBRT 91.5% vs RFA 87.0% ยท Difference +4.5%
Discussed by: @jryckman3, @NiuSanford
The NEST trial of neoadjuvant botensilimab/balstilimab in localized mismatch repair-proficient and -deficient colon cancer is now in print in Clin Cancer Res. The investigator cites UNICORN, which reported neoadjuvant botensilimab alone and botensilimab+balstilimab, as independent corroboration and as evidence that the PD-1 partner matters. In the refractory metastatic setting, botensilimab/balstilimab produced ORR 21%, mPFS 4.0 mo and mOS 21.2 mo in 123 heavily pretreated patients. The debate is whether neoadjuvant CTLA-4/PD-1 blockade is ready to be tested against surgery-first management in MMR-proficient localized colon cancer, or whether the signal still depends on the specific CTLA-4 backbone.
Discussed by: @pashtoonkasi, @pashtoonkasi, @DraMartinezLago
Sources cited: Neoadjuvant Botensilimab/Balstilimab for localized mismatch repair proficient and deficieโฆ (Clinical Cancer Research, 2026) ยท Extended Follow-up of Botensilimab plus Balstilimab in an Expanded Cohort of Microsatelliโฆ (Clinical Cancer Research, 2026)
Adding VCN-01 to gem/nab-paclitaxel did not significantly improve overall survival in the intent-to-treat population. PFS and OS gains appeared in the full analysis set, and duration of response roughly doubled. ORR, DCR and CA19-9 were flat, and serious virus-related events occurred in 22.6%. Clinicians framed the result as needing phase 3 confirmation, and the debate is whether a win confined to the full analysis set justifies that trial.
Key numbers: ITT mOS 10.6 vs 8.6 mo, HR 0.69 ยท FAS mOS 10.8 vs 8.6 mo, HR 0.57 ยท FAS PFS 7.0 vs 4.6 mo, HR 0.55 ยท DoR 11.2 vs 5.4 mo, HR 0.22 ยท 18-mo survival 31.1% vs 8.5%
Discussed by: @DrAllanPereira, @ilyassahinMD, @VivekSubbiah, @hongjaechon
Sources cited: Intravenous hyaluronidase-expressing oncolytic adenovirus with chemotherapy in metastaticโฆ (Nat Med)
A multicenter European study (n=1,947) in JHEP Reports found no survival benefit from maintenance chemotherapy after 8 cycles, and no benefit from continuing chemotherapy beyond 6 months. GEMOX was inferior to CisGem, which remains the backbone. In ECOG 2 patients, CisGem outperformed gemcitabine alone. The open question is whether real-world evidence is enough to stop first-line chemotherapy at six months, or whether that applies only to patients without access to a maintenance immunotherapy backbone.
Key numbers: GEMOX vs CisGem mOS 9.9 vs 11.4 mo, p=0.049 ยท PS2 CisGem vs Gem mOS 6.8 vs 3.6 mo, p<0.001
Discussed by: @ArndtVogel, @hongjaechon
Sources cited: Elsevier
Oncology Brothers @OncBrothers
And then in September 2026: we got 5 more new drugs/indications โ @FDADrugs!! As a #CommunityOncologists, we need to know them all:
1. #Camizestrant in mESR1 HR+ breast cancer (before progression). โฌ๏ธmPFS (16mos vs. 9.2mos)
2. #Imlunestrant + #Abemaciclib in 2L metastatic mESR1 HR+ breast cancer. โฌ๏ธmPFS (11.1mos vs. 5.5mos)
3. #Sevabertinib now in 1L Her2 mutated NSCLC. ORR 75%
4. #Lirafugratinib in 2L for FGFR2 fusion/rearrangement cholangiocarcinoma. ORR 46% and DoR 11.8mos
5. #Belzutifan + #Lenvatinib in 2L RCC. โฌ๏ธmPFS (14.6mos vs. 10.6mos)
#OncTwitter #bcsm #lcsm #gusm @OncUpdates @FDA @US_FDA
[Quoting @OncBrothers: What just happened in Oncology? 5 new drugs/indications โ @FDADrugs in August 2026. As a #CommunityOncologists, we need to know them all:
1. #Rusfertide in Polycythemia Vera, improved phlebotomy (76.9% vs. 32.9%)
2. #Daraxonrasib in 2L metastatic pancreatic cancer, mOS 13.2 Vs 6.7mos
3. #Zanidatamab + Chemo ยฑ Tislelizumab in 1L metastatic Her2+ GEA/Gastric adenocarcinoma, mOS 26.4mos Vs 19.2mos
4. #Iberdomide + Dara + Dex in 2L RRMM, improved MRD negativity (41% vs. 21%)
5. #Vusolimogene + Nivo in refractory Melanoma. ORR of 24.2% and mDOR: 14.1mos.
#pancsm #mpnsm #OncTwitter #HemeTwitter @OncoAlert @OncUpdates]
๐ 12 โค๏ธ 35 ๐ 13 ๐ 6,153
Hong Jae Chon @hongjaechon
๐จ Long-term data from Phase III #ASCOT trial confirms sustained survival benefit of adjuvant S-1 in resected #BTC! @JCO_ASCO @ASCO
๐ 5-Year Final Follow-up (N=440, median f/u 61.5 mo):
๐ 5-yr OS: 64% (S-1) vs. 52% (Obs) - HR 0.72 (95% CI 0.55โ0.95, p=0.01)
๐ Median OS: 8.2 yrs vs. 5.9 yrs
๐ Median RFS: 6.1 yrs vs. 3.5 yrs (stratified HR 0.76)
๐ง A solid benchmark. Next up: IO combos?
Full: https://t.co/2xzykK1hMs
@ILCAnews @myESMO @EASLnews #AdjuvantChemotherapy
๐ 2 โค๏ธ 17 ๐ 3 ๐ 1,209
Journal of Clinical Oncology @JCO_ASCO
Now out in #JCO
First-Line Retlirafusp Alfa Plus Chemotherapy for Human Epidermal Growth Factor Receptor 2โNegative Gastric or Gastroesophageal Junction Adenocarcinoma: A Randomized, Double-Blind, Phase III Study (RELIGHT).
Read the article. https://t.co/OrAOZt18aU https://t.co/fVsiZthagg
๐ 2 โค๏ธ 4 ๐ 3 ๐ 1,847
Lorenza Rimassa @LorenzaRimassa
RT @hongjaechon: ๐จ Long-term data from Phase III #ASCOT trial confirms sustained survival benefit of adjuvant S-1 in resected #BTC! @JCO_ASCO @ASCO
๐ 5-Year Final Follow-up (N=440, median f/u 61.5 mo):
๐ 5-yr OS: 64% (S-1) vs. 52% (Obs) - HR 0.72 (95% CI 0.55โ0.95, p=0.01)
๐ Median OS: 8.2 yrs vs. 5.9 yrs
๐ Median RFS: 6.1 yrs vs. 3.5 yrs (stratified HR 0.76)
๐ง A solid benchmark. Next up: IO combos?
Full: https://t.co/2xzykK1hMs
@ILCAnews @myESMO @EASLnews #AdjuvantChemotherapy
๐ 2 โค๏ธ 17 ๐ 3 ๐ 1,209
Lorenza Rimassa @LorenzaRimassa
RT @ArndtVogel: ๐ฅgreat news๐ฅ
FDA approves lirafugratinib for previously treated, unresectable, locally advanced or metastatic cholangiocarcinoma
https://t.co/u4Mr4ijEcu
๐expanding options for patients with FGFR2 fusions!
@myESMO @ASCO @ILCAnews @EASLedu https://t.co/liHhOAapzq
๐ 7 โค๏ธ 56 ๐ 28 ๐ 3,694
OncLive.com @OncLive
๐ฌ @benweinbergmd, of @Georgetown and @LombardiCancer, discusses the @FDA approval of daraxonrasib, RASolute 302 survival data, safety considerations, and the future of RAS-targeted therapies in pancreatic cancer. #pancsm #oncology
Read more โก๏ธ: https://t.co/WHKy7I8akw
๐ 1 โค๏ธ 3 ๐ 3 ๐ 982
Pashtoon Kasi MD, MS @pashtoonkasi
RT @pashtoonkasi: Full paper of my investigator initiated #NEST trial now available in print @CCR_AACR. Trending number 1 based on all the discussion and enthusiasm around neoadjuvant immunotherapy for patients with MSS colorectal cancer. New paradigm.
https://t.co/BPfr75Lvxm
@AACR @OncoAlert https://t.co/EqWwOhdgMB
๐ 11 โค๏ธ 40 ๐ 9 ๐ 6,221
Elad Sharon @EladSharonMD
RT @pashtoonkasi: Full paper of my investigator initiated #NEST trial now available in print @CCR_AACR. Trending number 1 based on all the discussion and enthusiasm around neoadjuvant immunotherapy for patients with MSS colorectal cancer. New paradigm.
https://t.co/BPfr75Lvxm
@AACR @OncoAlert https://t.co/EqWwOhdgMB
๐ 11 โค๏ธ 40 ๐ 9 ๐ 6,221
Rami Manochakian MD, FASCO @RManochakian
RT @OncBrothers: And then in September 2026: we got 5 more new drugs/indications โ @FDADrugs!! As a #CommunityOncologists, we need to know them all:
1. #Camizestrant in mESR1 HR+ breast cancer (before progression). โฌ๏ธmPFS (16mos vs. 9.2mos)
2. #Imlunestrant + #Abemaciclib in 2L metastatic mESR1 HR+ breast cancer. โฌ๏ธmPFS (11.1mos vs. 5.5mos)
3. #Sevabertinib now in 1L Her2 mutated NSCLC. ORR 75%
4. #Lirafugratinib in 2L for FGFR2 fusion/rearrangement cholangiocarcinoma. ORR 46% and DoR 11.8mos
5. #Belzutifan + #Lenvatinib in 2L RCC. โฌ๏ธmPFS (14.6mos vs. 10.6mos)
#OncTwitter #bcsm #lcsm #gusm @OncUpdates @FDA @US_FDA
๐ 16 โค๏ธ 44 ๐ 19 ๐ 7,471
OncLive.com @OncLive
ICYMI ๐ฅ: @FDA has approved lutetium Lu 177 dotatate injection for SSTR-positive GEP-NETs, including foregut, midgut, and hindgut NETs, marking a defining milestone.
Full details ๐ฐ: https://t.co/Ij1xyxBzzo
#oncology
๐ 0 โค๏ธ 2 ๐ 1 ๐ 1,598
CancerNetworkยฎ @CancerNetwrk
๐จ FDA approves Lutetium Lu 177 dotatate injection for patients with somatostatin receptor-positive GEP-NETs. #NETs #gicsm #radonc | @FDADrugs
https://t.co/HaEvHZjIVm https://t.co/tGULRhjZMX
๐ 3 โค๏ธ 2 ๐ 1 ๐ 858
Nieves Martinez Lago MD PhD @DraMartinezLago
RT @Erman_Akkus: ๐ฅTNT strategies in rectal cancer
#cancer #oncology #MedX @OncoAlert https://t.co/Bvsb4kMarY
๐ 209 โค๏ธ 284 ๐ 111 ๐ 15,456
Elad Sharon @EladSharonMD
RT @EricTopol: Personalized neoantigen vaccines have already been shown to improve outcomes for refractory malignant melanoma and in pilot studies of pancreatic cancer, glioblastoma, renal cell carcinoma and triple negative breast cancer. But they require a tumor biopsy to identify the antigens. A new study shows it's possible to get this from a blood sample.
https://t.co/v2cupJHwZA
๐ 81 โค๏ธ 253 ๐ 62 ๐ 33,527
Eric Topol @EricTopol
Personalized neoantigen vaccines have already been shown to improve outcomes for refractory malignant melanoma and in pilot studies of pancreatic cancer, glioblastoma, renal cell carcinoma and triple negative breast cancer. But they require a tumor biopsy to identify the antigens. A new study shows it's possible to get this from a blood sample.
https://t.co/v2cupJHwZA
๐ 81 โค๏ธ 253 ๐ 62 ๐ 33,527
Ronan Hsieh, MD, MS @ronanhsieh
RT @DraMartinezLago: ๐งฌ Reduced oxaliplatin exposure | GI cancers | Meta-analysis
๐ 24 studies (N=30,395)
โ No significant survival difference
โ Gโฅ3 neuropathy OR 0.34
โ Gโฅ3 AEs OR 0.67
๐ก Less oxaliplatin may improve the therapeutic index without survival loss.
๐ https://t.co/8yZIlgkSkL
@OncoAlert
๐ 50 โค๏ธ 72 ๐ 27 ๐ 4,944
3 trials (1 phase III, 1 phase II, 1 phase I) opened this week, testing cadonilimab, consolidative FOLFOX or FLOT chemotherapy and TS-104
Phase 3 ยท Akeso ยท cadonilimab ยท Arizona, California, Colorado, Connecticut, Massachusetts, Michigan +5 more ยท CT.gov โ
Phase 2 ยท Duke University ยท consolidative FOLFOX or FLOT chemotherapy ยท North Carolina ยท CT.gov โ
Phase 1 ยท TwoStep Therapeutics, Inc. ยท TS-104 ยท Ohio, Oregon, Virginia ยท CT.gov โ
Open all 3 on the trials page โ
Agent descriptions from the NCI Thesaurus.
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