Top 5 Papers
#1
Source: eClinicalMedicine (Lancet Discovery Science) | Authors: Reni M, Orsi G, Carconi C, Malleo G, Procaccio L, et al. — 17 academic hospitals across 10 Italian regions | Published: September 5, 2026
Score: 8/20 — Breakdown: base 5 (eClinicalMedicine — no base-score row in the scoring table; defaults to Other) + Phase III RCT (+3) = 8. No clinical-impact bonus applied: the primary endpoint was not met, so neither the survival-benefit nor the new-standard-of-care bonus is earned, despite uniformly positive pathological secondary endpoints.
The second randomisation of the Italian PACT-21/CASSANDRA phase 3 trial asked whether two additional months of preoperative chemotherapy improve outcomes in resectable and borderline resectable pancreatic ductal adenocarcinoma. Between February 2021 and September 2024, 86 patients were assigned to long and 79 to short preoperative chemotherapy with either PAXG or mFOLFIRINOX. The primary endpoint was not met — event-free survival was effectively identical between arms (unadjusted HR 0.98, 95% CI 0.68–1.41, p=0.90). Every pathological and biochemical secondary endpoint nevertheless favoured the longer schedule: CA19-9 response 58/60 (97%) versus 41/49 (84%), p=0.02; pathological complete response 4/86 (5%) versus 0/79, p=0.05; and N0 resection 39/86 (45%) versus 21/79 (27%), p<0.01. Overall survival data are not yet mature.
Post angle: The pathological response paradox in PDAC: two extra months of preoperative chemotherapy delivered more complete responses, more N0 resections and better CA19-9 response — and exactly the same event-free survival. Downstaging the specimen is not the same as changing the disease. #PDAC #PancreaticCancer #GIOnc #Neoadjuvant
#2
Source: ESMO Gastrointestinal Oncology | Authors: Puhr HC, Mozayani B, Korpan M, Kaya M, Kordik F, et al. — Medical University of Vienna | Published: September 2, 2026
Score: 7/20 — Breakdown: base 5 (ESMO Gastrointestinal Oncology) + retrospective/real-world cohort (+1) + biomarker-guided/prognostic (+1) = 7. No further clinical-impact bonus: only 175 of 692 patients had a documented tumour regression grade and the authors state multivariable analysis was limited by event numbers and missing data.
Tumour regression grade is routinely reported after neoadjuvant therapy in gastroesophageal adenocarcinoma, yet whether it adds prognostic information beyond pathological staging has remained uncertain. This single-centre retrospective cohort from the Medical University of Vienna covered 692 patients treated between 2006 and 2024; 394 received neoadjuvant systemic therapy and 175 had a documented TRG. Mandard TRG was significantly associated with both disease-free survival (p=0.03) and overall survival (p=0.0015), whereas Becker TRG was not. Lower TRG scores tracked with favourable ypT and ypN categories and with absence of lymphatic, venous and perineural invasion (all p<0.05), but classical pathological factors — ypT, ypN, ypV, ypPn and R status — remained the strongest prognostic determinants. Selection bias is real here: only a quarter of the full cohort had TRG recorded.
Post angle: Two tumour regression grading systems, one cohort, nineteen years: Mandard predicted survival, Becker did not. If your pathology reports treat these as interchangeable, this is an argument for standardising now — before perioperative chemo-immunotherapy makes regression grade matter even more. #GastricCancer #EsophagealCancer #GIOnc #Pathology
#3
Source: JCO Global Oncology | Authors: Howaidi J, Alnajjar F, Abu Alnasr R, Alanazi AS, Alhumaid M, et al. — King Fahad Medical City, Riyadh | Published: September 9, 2026
Score: 6/20 — Breakdown: base 5 (JCO Global Oncology — no base-score row in the scoring table; defaults to Other) + retrospective/observational (+1) = 6. No clinical-impact bonus: the finding is an absence of difference in an underpowered comparison, not a demonstrated survival benefit.
Leucovorin shortages are recurrent and global, and no guideline says what to do about them. This retrospective/prospective observational study from King Fahad Medical City in Riyadh compared the standard 400 mg/m² dose against a reduced 200 mg/m² dose, each given once on day 1 of each cycle, in 99 patients with metastatic colorectal cancer treated between 2020 and 2025; FOLFOX6 was the regimen in 67.3%. Median progression-free survival was essentially identical — 8.0 months with leucovorin-200 (95% CI 5.8–12.6) versus 8.1 months with leucovorin-400 (95% CI 3.9–16.3), p=0.943 — and median overall survival did not differ significantly (71 months versus not reached, p=0.336). The reduced dose was associated with substantially less grade 1 diarrhoea (18.4% versus 51%, p=0.001), and the protocol change spared 1,180 vials. The study was not powered for non-inferiority, so this is practical reassurance rather than formal equivalence.
Post angle: When pharmacy calls about a leucovorin shortage, this is the paper you want to have read. 99 patients, half at 200 mg/m² and half at 400: same PFS, same OS, less diarrhoea, 1,180 vials saved. Underpowered for non-inferiority — but far better evidence than the nothing we had before. #CRC #ColorectalCancer #GIOnc #DrugShortage
Additional Papers of Interest
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Surgical Endoscopy — Meta-analysis of 5 studies and 536 patients: temporarily interrupting clopidogrel before small-polyp polypectomy reduced immediate post-polypectomy bleeding (RR 0.44, 95% CI 0.20–0.96) with no significant increase in delayed bleeding or cardioembolic events, though significance was lost in leave-one-out sensitivity analysis.
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