Low-dose aspirin to reduce recurrence rate in colorectal cancer patients with PI3K pathway alterations: 3-year results from a randomized placebo-controlled trial. LBA125Background: Colorectal cancer (CRC) affects 1.9 million individuals globally each year. Among patients with stage II-III CRC, 20-40% develop metastatic disease. Aspirin lowers the incidence of a...

PI3k mutations occur with ~ 35% prevalence. Are these outcomes worth performing genetic testing on all patients? Or maybe all resected CRC patients should get aspirin?
All I know is I now have a big bottle of aspirin in my clinic...
ascopubs.org/doi/10.1200/...

Low-dose aspirin to reduce recurrence rate in colorectal cancer patients with PI3K pathway alterations: 3-year results from a randomized placebo-controlled trial. LBA125Background: Colorectal cancer (CRC) affects 1.9 million individuals globally each year. Among patients with stage II-III CRC, 20-40% develop metastatic disease. Aspirin lowers the incidence of a...

Aspirin can prevent colon cancer?
ALASCCA was a mic drop presentation at GI-ASCO earlier this year, but hasn't gotten the press it deserves.
Pop: 1100 Resected colorectal cancer patients with PI3k mutation
Intervention: 160mg Aspirin x 3 years
Outcome: DFS HR .61 🤯, TTR .49

CheckMate 8HW is out and has ushered in a new era for dMMR mCRC.

However, any thoughts on using dual checkpoint inhibition for patients with advanced age or poor functional status?

Dual checkpoint in 90+? 80+? Start with single agent and rescue with CTLA4 if required? Age is just a number...

#GI25
Trying to stay up to date with the massive amount of data in colorectal cancer?

Here is one slide summarizing the three major Phase III studies!

Generally agree with these thoughts (also shoutout to pan-KRAS, aspirin, Celecoxib and Bot + Bal).

4. Aspirin and Celecoxib may have clinical benefit!?

5. ctDNA is here to stay, but we need to identify actionable strategies

#GI25
As GI-ASCO comes to a close I think there are a few takeaways.

1. Progress continues to march forward. dMMR disease is increasingly a systemically managed disease with excellent cure fraction (embrace CTLA4)

2. IO is breaking into MSS CRC

3. The undruggable is becoming druggable

Lanreotide + Everolimus more than doubled PFS for first line NET compared to everolimus alone. Given comparison to everolimus and not SSA based therapy takeaways are unclear.

PFS was 29.7 months in the everolimus plus lanreotide group vs 11.5 months in the everolimus monotherapy group.

NIH supported activities are being suspended, including NIH study sections.

For the layperson:

No study sections -> No grant review
No grant review -> No new grants
No new grants -> No studies
No studies -> No new science or clinical trials

This weakens America as a whole.
#GI25

α-CORRECT with a brutal sensitivity of only 48% in stage III CRC.

meetings.asco.org/abstracts-pr...

ctDNA in BTC!

meetings.asco.org/abstracts-pr...

More ctDNA data than you can shake a stick at!

Early conversion of ctDNA status a good predictor of patients appropriate for watch and wait in rectal cancer (not just 1, but 2 studies!).

meetings.asco.org/abstracts-pr...

meetings.asco.org/abstracts-pr...

Some real world data of immunotherapy use in MSI-H Colon Cancer showing benefit in patients with peritoneal mets (and more interestingly) significant benefit to primary tumor resection with a HR .44).
meetings.asco.org/abstracts-pr...

OrigAMI-1 readout showing s 22% ORR to amivantamab monotherapy.
meetings.asco.org/abstracts-pr...

#GI25 abstracts are out!
Almost 1000 abstracts and presentations!
Some highlights

CAR T For Solid Tumor (CRC)
GCC19 CART for refractory mCRC with a response rate of 80% at dose level 2! Some responses included complete metabolic response on PET (jaw dropping).
meetings.asco.org/abstracts-pr...

Take away? Unclear if waiting for radiographic progression and surgery is best. Systemic therapy likely preferable in these patients... More studies to come soon.

Circulating Tumor DNA Testing in Curatively Resected CRC and Salvage Resection This cohort study examines the potential curative clinical outcomes of adding serial circulating tumor DNA assays to standard-of-care imaging surveillance in patients with resected colorectal cancer (...

Hot off the presses
ctDNA in Curatively Resected Colorectal Cancer
184 patients (mostly Stage II/III)
No OS/DFS. 3 month lead time for ctDNA. Most recurrences occurred in the liver.
Only 1.6% remained disease free following their metastectomy.
jamanetwork.com/journals/jam...

Something new in BRAF V600E mCRC!
#BREAKWATER
Enco + Cetux + FOLFOX

Nice increase in ORR (61% vs 40%)
~ 3 month increase in PFS (14 vs 11 months)

AEs likely will dictate uptake.

Ready for prime time? Huge progress in the disease by
@skopetz.bsky.social

Time to give back to the cycle of academic life as an editor for JCO Oncology Advances.
Looking forward to reading about cutting edge advances in GI Oncology.

22 years ago I remember sitting in junior high biology, being told I wasn't smart enough to be doctor. Today I passed the final "test" to be considered an oncologist. To everyone who helped me along the way and took time to mold me, thank you. To Mr. Didden, guess you were wrong.

Congrats to everyone that matched yesterday!
Amazing seeing the popularity of some specialties compared to others.

Wonder what the follow-up time is...

We're around!

Another tool in the anti-cancer armamentarium!
⚕️Zanidatamab FDA approved for HER2+ Biliary Tract Cancer (BTC).
Includes Gallbladder and Cholangiocarcinoma
🔥Outstanding Responses!

Pan-cancer approvals like NTRK fusion inhibitors highlight the power of genomics: treating cancers by mutation, not just origin. With sequencing under $1000, we can identify actionable targets faster, bringing hope to patients with rare mutations and driving precision oncology forward.

In 1977, Sanger sequencing laid the groundwork for decoding life. Fast forward to today: high-throughput sequencing delivers whole genomes in hours, not years. The cost? From $100M to <$1000 per genome—a revolution transforming oncology and precision medicine.