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Milestones and New Research from ASCO GI 2023

Op-Med is a collection of original articles contributed by Doximity members.

For 20 years, the ASCO Gastrointestinal Cancers Symposium has brought the international GI cancer care community together to discuss the latest science, practice updates, and treatment advances in the field. I was thrilled to join nearly 4,600 attendees from 60 countries at this year’s conference to celebrate this milestone and discover new research that will transform how we care for our patients today and in the future. 

The highly anticipated results of several large phase III studies were presented at this year’s symposium, identifying potentially new standards of care for certain patients with advanced biliary tract, gastric, gastroesophageal junction, colorectal, and liver cancers. Many big trial names were trending in discussions among attendees and on social media, including the FIRE-4, INFINITY2, NAPOLI-3, SWOG S1815, IMbrave151, and PARADIGM trials, to name a few.

One of the most talked about studies was presented on the first day of the meeting. The SPOTLIGHT trial found that zolbetuximab (an investigational monoclonal antibody targeting CLDN18.2) in combination with first-line chemotherapy (mFOLFOX6) led to significantly longer progression-free survival and overall survival in patients with claudin 18.2-positive/HER2-, unresectable or metastatic gastric or gastroesophageal junction adenocarcinoma. Lead study author Dr. Kohei Shitara concluded that the 18.2-month overall survival seen in the zolbetuximab arm may be “the longest median survival in a global phase III trial for gastric cancer” and that the combination represented a “new potential standard treatment for these patients.” 

The symposium also featured research focused on improving pain management and expanding clinical trial enrollment. Both can lead to better, more equitable care for our patients. Two studies led by Dr. Laura Dawson et al., could potentially improve the quality of life for patients with advanced liver cancer. LBA492 showed that low-dose radiation therapy should be considered a standard palliative intervention to improve hepatic cancer pain. A second study, the phase 3 NRG/RTOG 1112 trial, showed that personalized stereotactic body radiation therapy added to sorafenib was associated with improved outcomes — with no concerning increase in adverse events — compared to sorafenib alone. An analysis of the FIRE-4 trial of FOLFIRI/cetuximab comparing patients who received one initial cycle of chemotherapy alone while awaiting RAS mutational analysis versus patients who received cetuximab with the first cycle demonstrated that one cycle of standard chemotherapy before randomization did not negatively impact the primary endpoint of progression-free survival, helping reduce patient and provider concerns about initiating treatment with RAS status pending and improving patient enrollment to clinical trials.

An analysis of antibiotic use in the phase III TOPAZ-1 study answered an important clinical question by demonstrating that patients with advanced biliary tract cancer can safely be treated with antibiotics while still benefiting from treatment with durvalumab plus chemotherapy. In a randomized Phase 2 trial, nanvuranlat, a LAT1 inhibitor, improved progression-free survival compared to best supportive care in patients with refractory biliary tract cancer. Further investigation in a more diverse patient population is warranted to validate the efficacy shown in this study and assess treatment-related toxicities, but this could offer these patients a new treatment option. 

Friday’s keynote lecture by Dr. Matthew Lungren, an interventional radiologist and machine learning researcher, touched on another hot topic—artificial intelligence. Dr. Lungren began his talk by addressing ChatGPT, or what he referred to as the “elephant in the room.” His thought-provoking remarks touched on how artificial intelligence is moving from engineering to biology, what it means for society as a whole, and how the oncology community needs to “rise up and meet this technology as it’s accelerating almost past us.” His plea to the audience to come to a middle ground and collaborate more with our data-science partners to exert further control over these emerging technologies so we can figure out how to use them responsibly and safely in our practices was well received. 

Social media was also buzzing about a study of food insecurity (defined as inconsistent access to enough food for every household member to have an active and healthy life) measures and deaths from GI cancers in the United States that found that areas with high levels of food insecurity had greater rates of GI cancer mortality. This study highlights the need to include food insecurity as part of our work in medicine to address social determinants of health to improve outcomes for all patients. 

The interesting and inspiring educational sessions, practice-changing science, and abundant career- and relationship-building opportunities were my biggest highlights from this year’s ASCO GI Cancers symposium. I was excited to see the conversations happening outside the session rooms, in the Exhibit Hall and during breaks at the ASCO Breakthrough booth. 

Thanks to our multidisciplinary experts putting the science into context, attendees were provided with a truly holistic view of the latest innovations in the GI field. Most importantly, the symposium demonstrated how our community continues to work hard to improve the lives of people living with cancer across the globe.

Dr. Gralow has no conflicts of interest to report.

Image by VectorSpace06 / Shutterstock

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