GI OncoPulse

📊 Non-chemotherapy agents in advanced gastric cancer: marginal gains, real trade-offs. This systematic review and meta-analysis (6 RCTs, n=2378) evaluated immunotherapy and targeted therapy versus best supportive care (BSC) or placebo in third-line or later treatment of advanced GC. Key findings: • Overall survival improved modestly (HR 0.78 → +~1.1 months) • Progression-free survival improved (HR 0.52–0.60) • Grade ≥3 adverse events increased, notably with IO (RR 2.72) • No consistent improvement in quality of life 🧍 Most trials excluded ECOG ≥2 patients. None incorporated biomarker selection. 🛑 QoL, symptoms, and hospital admissions often unreported. BSC varied across studies. Conclusion: In highly selected fit patients, IO/targeted agents may offer small gains. But for most with advanced GC, these findings urge caution and reinforce shared decision-making. 🔗 Full study: https://lnkd.in/eT8nc3yn #GastricCancer #HPBsurgeon #GIoncology #PalliativeCare #SurgicalOncology #MedicalOncology #TargetedTherapy #Immunotherapy

🔍 Network meta-analysis spotlight – Bowel preparation regimens for colonoscopy: This 22-RCT analysis (n=7179 for CS, n=6639 for ADR) compared 14 different bowel prep strategies under consistent split-dose protocols. ✅ Top performer for cleansing success (CS): • 2L PEG + lactulose (SUCRA 0.94) • 2L PEG + simethicone (SUCRA 0.93) 📈 Only 2L PEG + simethicone significantly improved adenoma detection rate (RR = 1.60 [95% CI 1.05–2.43]) over the reference (2L PEG + ASC). Notably, 4L PEG + simethicone and 2L PEG + ASC ranked among the least effective. 📚 These findings challenge routine prep protocols and favor low-volume, adjunct-based regimens. Larger, ADR-powered RCTs are still needed for definitive guidance. 🔗 Full article: https://lnkd.in/eu29wHrR #Colonoscopy #GIoncology #HPBsurgeon #Endoscopy #BowelPrep #SurgicalOncology #Gastroenterology

📘 The 2025 ASTRO Focused Update on Radiation Therapy for Rectal Cancer reflects a dramatic evolution in management pathways. This guideline integrates findings from landmark trials (OPRA, PROSPECT, RAPIDO, PRODIGE-23) to support nuanced and risk-adapted care. Key updates include: ✅ Total Neoadjuvant Therapy (TNT) is strongly recommended for cT3-4 or N+ rectal cancer. ✅ Selective omission of RT is conditionally supported in lower-risk patients (cT2–T3a/b, >5cm from AV, CRM ≥2mm, no EMVI) after favorable response to chemo. ✅ Non-operative management (NOM): now a conditionally recommended strategy for patients achieving clinical CR post-TNT—backed by long-term OPRA data. ✅ MSI-H/MMRd tumors: Immune checkpoint inhibition may obviate the need for chemoradiation and surgery. ✅ RT dosing for NOM: 5000–5600 cGy w/ concurrent chemo, using IMRT/SIB/VMAT as needed. These updates emphasize multidisciplinary decision-making, integration of molecular profiling, and alignment with patient quality-of-life goals. 📄 Full guideline: https://lnkd.in/enJJE7TM #GIoncology #HPBsurgeon #RectalCancer #RadiationOncology #SurgicalOncology #TNT #OrganPreservation #MSI #Immunotherapy #NOM #ColorectalCancer

📢 Just released: 2025 AHPBA Consensus Guidelines on Colorectal Liver Metastases (CRLM) This comprehensive update emphasizes the critical role of the HPB surgeon in early evaluation and treatment sequencing. Some key highlights: ✅ Imaging: Hepatobiliary MRI + DWI remains the most sensitive modality (91.4%), particularly for sub-centimeter lesions. ✅ Volumetry: Resectability hinges on functional liver remnant thresholds—≥20–25% (normal), ≥30% (CALI), ≥40% (cirrhosis). ✅ Molecular Profiling: RAS, BRAF, and TP53 co-mutations predict worse OS; however, mutation status does not currently preclude resection. ✅ Treatment Sequencing: Neoadjuvant chemotherapy lacks survival benefit in resectable CRLM; upfront surgery is often appropriate. ✅ Unresectable CRLM: HAI therapy shows survival benefit in high-volume centers; liver transplant yields 5-year OS up to 83% in highly selected patients (SECA-II). This document affirms that early surgical involvement is not optional—it’s essential. 📝 Full text: https://lnkd.in/euZXFpVJ #HPBsurgeon #GIoncology #ColorectalCancer #SurgicalOncology #LiverMetastases #Hepatobiliary #CRLM #LiverSurgery

🚨 The preSINO trial (BJS, 2025) provides a critical diagnostic foundation for organ-preserving strategies in esophageal squamous cell carcinoma (OSCC). ✅ In 309 patients with locally advanced OSCC: CREs using bite-on-bite biopsies + EUS-FNA after CROSS-based nCRT achieved: • Sensitivity: 81.7% • Specificity: 93.2% • False-negative rate (FNR): 13.5% for TRG3–4 or TRG1–2 + ypN+ residual disease PET-CT identified interval metastases in 4.9% preoperatively Exploratory ctDNA analysis: • ctDNA-positive patients had 28% systemic recurrence vs. 5.3% if ctDNA-negative • Adding ctDNA dropped FNR to 5.4% 🧬 These data support a tri-modal CRE approach with potential ctDNA integration in future SINO trials. 🧾 Full article: https://lnkd.in/dZhZ8PSQ #GIoncology #EsophagealCancer #NeoadjuvantTherapy #ctDNA #SurgicalOncology #OrganPreservation #HPBsurgeon #MolecularOncology

📌 Neoadjuvant chemotherapy (NAC) is showing real promise in locally advanced colon cancer (LACC). This 2024 BJS meta-analysis pooled data from 7 high-quality studies (n=2120 patients) and found that NAC, compared to upfront surgery: ✅ Improves 5-year OS (79.9% vs 72.6%) ✅ Improves 5-year DFS (73.1% vs 64.5%) ✅ Reduces the hazard of death (HR 0.67) and recurrence (HR 0.73) ✅ Lowers incomplete resection risk (OR 0.70) ❌ Does not increase perioperative mortality or major complications 🔍 Importantly, the survival curves only began to separate at ~12 months—suggesting long-term benefit likely driven by micrometastatic control and enhanced R0 rates. 🧾 Full article: https://lnkd.in/dMjiWWHT #ColorectalCancer #NeoadjuvantTherapy #GIoncology #HPBsurgeon #SurgicalOncology #OncologyResearch #CancerSurgery #EvidenceBasedMedicine

📌 CAPRI-2 GOIM trial (ESMO Open, 2025) highlights the clinical utility of liquid biopsy–based CGP in metastatic colorectal cancer (mCRC) treated with FOLFIRI + cetuximab. Key takeaways: ✅ Negatively hyper-selected patients (no resistance mutations in RAS/BRAF/EGFR/PIK3CA etc.) had: ORR: 78.1% Median PFS: 12.4 months ✅ High clonality of resistance mutations (esp. RAS/BRAF V600E) = poor response (ORR ~30%, PFS ~3.4 months) ✅ After 1L failure, ~79% retained RAS/BRAF WT ctDNA, supporting continued anti-EGFR with a new chemo backbone This trial demonstrates how real-time, longitudinal LBx can optimize biologic sequencing—and stratify who shouldn’t receive EGFR blockade. Full text: https://lnkd.in/exRdc3zN #GIoncology #mCRC #LiquidBiopsy #Cetuximab #MolecularOncology #SurgicalOncology #PrecisionMedicine #RASWT #ColorectalCancer

📣 Landmark data from the SANO trial (Lancet Oncology, Mar 2025) supports a non-inferiority approach to managing esophageal cancer in patients with a clinical complete response after CROSS-based neoadjuvant chemoradiotherapy. 🧪 Study design: Multicentre, stepped-wedge, phase 3 trial (n=309) across 12 Dutch centers. 📊 Key findings: 2-year OS: 74% (active surveillance) vs 71% (surgery) ~35% avoided esophagectomy Postponed surgery did not lead to increased R1 resections or mortality Surveillance group had better short-term quality of life Most regrowths detected within 6–12 months, enabling timely salvage These data support using clinical response assessments to guide surgery, especially for patients prioritizing QOL and in shared decision-making discussions. 🧾 Full article: https://lnkd.in/eDHU7JgW #GIoncology #HPBsurgeon #EsophagealCancer #OrganPreservation #WatchAndWait #NeoadjuvantTherapy #SharedDecisionMaking #SurgicalOncology

🧠 Thoughtful restraint is key in modern GI oncology. The SEEN 2025 “do-not-do” recommendations include several clinically relevant pearls for HPB surgeons and GI cancer specialists: ✅ PanNET workup: Avoid pancreatic imaging in hypoglycemia unless Whipple’s triad and endogenous hyperinsulinism are proven. ✅ Chromogranin A testing: PPIs must be withdrawn ≥2 weeks before CgA testing to reduce false positives and unnecessary workups. ✅ Nutritional status: Serum albumin is not a valid nutritional marker in surgical or hospitalized patients—bioimpedance or structured tools are preferred. ✅ Cushing's screening: Routine testing in obesity, without clinical red flags, offers low yield and may lead to overdiagnosis. Full article: https://lnkd.in/egGMQHtG #GIoncology #HPBsurgeon #SurgicalOncology #NeuroendocrineTumors #NutritionInCancerCare #PancreaticCancer #EndocrineOncology #ChoosingWisely #EvidenceBasedMedicine

Here is the latest edition of GI Oncology Insights. Our monthly newsletter. https://lnkd.in/ebWf5eH4