Top 5 Papers
#1
Source: Lancet Oncology | Authors: Bach SP, de Wilt JHW (senior), and the STAR-TREC Collaborative — multicentre, 37 sites across 5 European countries | Published: August 23, 2026
Score: 15/20 — Lancet Oncology base (8) + phase 2/3 randomised trial (+3) + potential new standard of care for response-adapted organ preservation (+3) + colleague engagement (+1: one GI oncology KOL posted it within 72h)
STAR-TREC randomised 409 patients (modified ITT: 163 long-course chemoradiotherapy, 168 short-course radiotherapy, 78 primary TME) across 37 sites in five European countries to test which radiotherapy schedule better supports response-adapted organ preservation in early- and intermediate-stage rectal cancer. At 12 months, TME-free survival among patients pursuing organ preservation was 78.5% with long-course chemoradiotherapy versus 60.6% with short-course radiotherapy (HR 1.90, 95% CI 1.29-2.81) — a substantial separation in the proportion of patients still keeping their rectum. Grade 3-4 gastrointestinal serious adverse events were low and similar in both radiotherapy arms (2% LCCRT, 4% SCRT) and highest with upfront surgery (8% primary TME). Importantly, the prespecified primary endpoint sits at 30 months, so this is a strong interim signal about which schedule to build a watch-and-wait pathway on, not yet the final verdict.
Post angle: Organ preservation in rectal cancer has moved from fringe to plannable — and STAR-TREC says the radiotherapy schedule you choose up front decides how many patients get to keep their rectum. #GIOnc #RectalCancer #OrganPreservation
#2
Source: Lancet Oncology | Authors: Song Z, Cheng X (senior) — multicentre, 7-9 hospitals in China | Published: September 2026 (online August 24, 2026)
Score: 11/20 — Lancet Oncology base (8) + phase 2 (+2) + biomarker-guided precision combination (+1). No clinical-impact bonus applied: the randomised comparison did not reach statistical significance.
This trial paired ifebemtinib, a focal adhesion kinase (FAK) inhibitor, with the KRAS G12C inhibitor garsorasib in previously treated KRAS G12C-mutated metastatic colorectal cancer, on the rationale that FAK signalling drives adaptive resistance to KRAS blockade. In the randomised phase 2 portion (n=51 total, 36 randomised), confirmed objective response rate was 38.9% with the combination versus 16.7% with garsorasib alone — a 22.2 percentage-point difference, but with a wide confidence interval (95% CI -7.7 to 49.1) and a one-sided p=0.068 that did not cross the significance threshold. A separate single-arm cohort reported an ORR of 46.7% (95% CI 21.3-73.4). The direction of effect is consistent and the mechanism is plausible, but 36 randomised patients cannot adjudicate a doubling of response rate; this is a signal worth a properly powered trial, not a result to act on.
Post angle: Adding FAK inhibition to a KRAS G12C inhibitor more than doubled response rate in mCRC — and still missed significance with 36 randomised patients. A lesson in how small a randomised phase 2 can be. #GIOnc #CRC #KRAS
#3
Source: ESMO Open | Authors: Akpinar R, Viganò L (senior) — single institution, Humanitas Research Hospital, Milan | Published: August 20, 2026
Score: 10/20 — Society open-access oncology journal base (6) + retrospective cohort (+1) + prognostic stratification that refines precision decision-making (+1) + colleague engagement (+2: two GI oncology KOLs engaged with it within 72h)
Among 180 patients who underwent resection of multiple colorectal liver metastases after preoperative chemotherapy, this Milan group graded pathological response lesion by lesion across 705 individual nodules rather than assigning one response category per patient. Heterogeneous response — different lesions in the same liver responding differently to the same systemic therapy — was the rule rather than the exception, occurring in 45% of patients by tumour regression grade and 53% by percentage of viable tumour cells. Prognostically, the presence of even a single well-responding lesion mattered: patients with heterogeneous response including at least one TRG 1-2 metastasis had 3-year overall survival of 56.4% versus 43.4% for those whose lesions all responded poorly (p=0.033), overlapping with the uniformly good responders. The practical implication is that whole-patient response grading averages away information that is sitting in the pathology report.
Post angle: We grade the patient. The biology is per-lesion. In 705 resected colorectal liver metastases, one well-responding nodule was worth 13 percentage points of 3-year survival. #GIOnc #CRC #LiverMetastases
#4
Source: ESMO Open | Authors: Masuishi T, Hong DS (senior) — multicentre, international | Published: August 19, 2026
Score: 9/20 — Society open-access oncology journal base (6) + biomarker-guided KRAS G12C-directed triplet (+1) + colleague engagement (+2: two GI oncology KOLs engaged with it within 72h). Phase 1b is excluded from the study-type bonus, and a single-arm cohort cannot claim a comparative survival benefit. Placed above EMB-01 at the same score on clinical impact — a 56.5% response rate in a genotype-selected population is a materially different signal from 12.5%.
Subprotocol H of the CodeBreaK 101 platform study added FOLFIRI chemotherapy to the sotorasib plus panitumumab backbone in 46 patients with previously treated KRAS G12C-mutated metastatic colorectal cancer. Confirmed objective response rate was 56.5% (95% CI 41.1-71.1), with median progression-free survival of 8.3 months (95% CI 7.0-11.0) and median overall survival of 17.9 months (95% CI 13.0-23.3), on a manageable safety profile. Those figures sit meaningfully above what the sotorasib-panitumumab doublet delivered in the randomised phase 3 CodeBreaK-300 trial, which is the natural comparison a reader will make. The caveat is structural rather than statistical: this is a single-arm phase 1b cohort of 46 patients with no randomised control, so cross-trial comparison is suggestive of where the regimen should go next, not evidence that it is superior.
Post angle: Sotorasib + panitumumab + FOLFIRI in KRAS G12C mCRC: ORR 56.5%, mPFS 8.3 mo, mOS 17.9 mo. Chemo on top of the targeted backbone looks like the direction of travel. #GIOnc #CRC #KRAS
#5
Source: Clinical Cancer Research | Authors: Xu T, Li J (senior), with Parseghian CM (MD Anderson) — multicentre, China and United States | Published: August 24, 2026
Score: 9/20 — Clinical Cancer Research base (6) + phase 1b/2 with antitumour activity as the phase 2 primary endpoint (+2) + biomarker-defined responding subgroup (+1)
EMB-01 is a bispecific antibody engaging both EGFR and c-MET, tested at 1600 mg IV weekly in a phase 1b/2 study that enrolled 52 patients, 48 of them with heavily pretreated metastatic colorectal cancer. The confirmed objective response rate across all mCRC patients was a modest 12.5% (95% CI 4.7-25.2), with a median duration of response of 32.0 weeks. The more informative number is where those responses came from: every single one occurred in a favourable subgroup of left-sided, RAS/RAF wild-type patients naive to fruquintinib, regorafenib and trifluridine-tipiracil (n=29), where confirmed ORR was 20.7% and median progression-free survival 19.0 weeks. Toxicity was not trivial — grade 3 or higher treatment-related adverse events occurred in 63.5%, dominated by rash (25.0%) and acneiform dermatitis (17.3%), the expected EGFR-class signature. Dual EGFR/c-MET blockade remains a reasonable hypothesis for bypass-track resistance, but this dataset defines a narrow population rather than a broad one.
Post angle: EMB-01 hit 12.5% response across heavily pretreated mCRC — but 100% of the responses came from one favourable subgroup. Read the denominator before the headline. #GIOnc #CRC #PrecisionMedicine
Additional Papers of Interest
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Annals of Surgery — Across 75 resection specimens from SANO trial patients whose cancer regrew during active surveillance, tumour involved the mucosa in 91% and the submucosa in 88%, supporting endoscopy as the detection tool; but only 5% were confined to the mucosa and nodal disease was present even in some superficial regrowths, so surgery remains the recommended treatment.
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Journal of Hepatology — 3,743 patients across international centres: pre-existing chronic liver disease was linked to more localized disease at diagnosis (57% vs 43%), more curative-intent surgery (60% vs 48%), and longer median OS (12.2 vs 11.1 mo, HR 0.88, 95% CI 0.80-0.98), with a larger effect in intrahepatic disease (14.2 vs 11.1 mo, HR 0.77).
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Gut — A proposed conceptual model arguing that sporadic microsatellite-stable early-onset CRC and a subset of post-colonoscopy CRC represent exposure-driven accelerated carcinogenesis that compresses the adenoma-carcinoma timeline, with implications for screening intervals and risk stratification.
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British Journal of Cancer — In 147 patients treated with nivolumab plus chemotherapy, a computational positive cell ratio derived from PD-L1 28-8 slides matched CPS on AUC (0.601 vs 0.586) but reclassified patients significantly better (p=0.0269), separating responders more sharply at the cut-off (ORR 56.03% vs 25.81%).
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British Journal of Cancer — Spatial single-cell profiling of 12 primary PDAC tumours found basal-like cells enriched in hypoxic regions; organoids grown at 1% O2 retained basal-like traits and reduced chemosensitivity, while standard normoxic culture drifted toward the classical subtype — a methodological correction for anyone using organoids as a drug-response model.
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Gastroenterology — Mayo Clinic prospective cohort reporting clinical outcomes for patients whose pancreatic cysts carry worrisome features or high-risk stigmata, the surveillance population where the balance between resection and continued imaging is least settled.
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