Keypoints:
• DYNAMIC III: Discover how ctDNA-guided adjuvant chemotherapy in stage 3 colon cancer did not improve outcomes, highlighting questionable role of escalating approach with ctDNA positivity.
• ATOMIC: Learn about the addition of atezolizumab to FOLFIRI in MSI-H disease stage 3 colon cancer, which improved disease-free survival with a hazard ratio of 0.50.
• BREAKWATER: Explore how the combination of encorafenib, cetuximab, and FOLFOX has established a new standard of care for BRAF V600E mutant metastatic colorectal cancer, doubling overall survival from 15 months to 30.3 months.
• MATTERHORN: Understand the use of durvalumab in the perioperative and postoperative setting with the FLOT regimen for resectable gastric and GE junction adenocarcinoma, showing significant improvements in event-free survival.
• DESTINY Gastric04: Delved into the findings that confirm TDXd as a preferred option in the second line and beyond for HER2 positive metastatic gastric cancer or GE junction adenocarcinoma.
In this episode of the Oncology Brothers podcast, we dived into the significant updates from the ASCO 2025 annual meeting, focusing specifically on gastrointestinal (GI) malignancies. Drs. Rahul & Rohit Gosain were joined by Dr. Cathy Eng, a leading GI medical oncologist from the Vanderbilt Ingram Cancer Center, who helped to unpack five pivotal abstracts that were presented at ASCO 2025.
We started with the DYNAMIC III study, which explored the use of circulating tumor DNA (ctDNA) to guide adjuvant chemotherapy in stage 3 colon cancer. Surprisingly, the study found that ctDNA-guided treatment did not improve outcomes, reinforcing its role as a poor prognostic marker rather than a predictive one.
Next, we discussed the ATOMIC trial, a plenary study that evaluated the addition of atezolizumab to FOLFIRI in MSI-high stage 3 colon cancer. This combination showed a significant improvement in disease-free survival, with a hazard ratio of 0.50, potentially redefining adjuvant therapy for this patient subset.
We then moved on to the BREAKWATER trial, which established a new standard of care for BRAF V600E mutant metastatic colorectal cancer. The combination of encorafenib, cetuximab, and FOLFOX resulted in a remarkable doubling of overall survival, from 15 months to 30.3 months.
Following that, we shifted our focus to upper GI malignancies, we covered the MATTERHORN study, which evaluated the use of durvalumab in combination with the FLOT regimen for resectable gastric and GE junction adenocarcinoma. This study demonstrated an improvement in event-free survival, suggesting it may become the new standard of care.
Finally, we discussed the DESTINY Gastric04 study, which confirmed TDXd as a preferred option in the second-line treatment of HER2-positive metastatic gastric cancer or GE junction adenocarcinoma, showing improved overall survival.
We wrapped up the episode by summarizing these key findings and their implications for clinical practice.
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