Thatcher Heumann

ICI prior to transplant ✅, but for how long❓ Check out our most recent publication! > Shorter ICI → ↑ recurrence > Optimal duration ≈ ≥80 days journals.lww.com/lt/abstract/99… @AASLDtweets @UHNTransplant @ArndtVogel

Erdafitinib in Patients with FGFR-Altered Advanced or Metastatic Cholangiocarcinoma | Clinical Cancer Research | American Association for Cancer Research aacrjournals.org/clincancerres/…

Not all chemo toxicity needs dose reduction. A new phase III NEJM trial shows romiplostim can prevent chemotherapy dose delays caused by thrombocytopenia. For years, chemotherapy-induced thrombocytopenia (CIT) has forced oncologists to reduce or delay treatment. This study tests whether a TPO receptor agonist can maintain dose intensity. 🧪 Trial design Phase III, double-blind RCT Patients: GI cancers on oxaliplatin-based chemotherapy with persistent CIT Randomization: Romiplostim vs placebo (2:1) N = 165 📊 Primary endpoint No CIT-related chemo dose modification in cycles 2–3 📈 Results • No chemo dose modification: 84% vs 36% • Odds ratio: 10.16 • Platelet response: 97% vs 77% • Median platelet recovery: 1.1 vs 2.1 weeks ⚠️ Safety Grade ≥3 adverse events: 37% vs 22% 🎯 Takeaway Romiplostim significantly reduces chemotherapy delays and dose reductions from thrombocytopenia, potentially preserving dose intensity in GI cancer chemotherapy. If confirmed in broader populations, this could become the first effective strategy for CIT management. 🔖 Save this for clinic. 📖 Full paper in comment ⬇️ #OncoTwitter #MedTwitter #GIcancer #Thrombocytopenia @OncoAlert @ASCO @myESMO @NEJM

🧬 MSI-H/dMMR cholangiocarcinoma 📍 Real-world propensity-matched study (JHEP Reports) 👥 331 pts | MSI-H/dMMR: 6.9% 📊 ICIs-based therapy • mPFS 64.1 vs 7.2 mo • mOS 70.5 vs 14.0 mo (vs MSS) 🎯 MSI-H/dMMR emerges as a key predictive biomarker 🔗 doi.org/10.1016/j.jhep… @GrupoTTD @OncoAlert

New NEJM RCT: neoadjuvant “GOLP” (gem-ox + lenvatinib + toripalimab) vs upfront surgery in resectable high-risk intrahepatic CCA. n=178. I seriously can’t believe that is the regimen name. 🟢 EFS: 18.0 vs 8.7 mo (p<0.001) ✅ crossed boundary 🟡 OS: HR 0.43, p=0.005 — sounds great, doesn’t meet significance (α=0.0019). Correct read: no OS benefit demonstrated. 🔴 Toxicity: AEs in 97% of pts in neo arm vs 70% control. Gr3+ in 28%. Three takes: 1.“GOLP”… One of the worst regimen names in recent memory. 2.The trial allocated almost no alpha to OS. Don’t let the HR fool you. 3.Near-universal AEs in the neoadjuvant arm for a disease where we don’t yet know if this translates to survival. EFS benefit is important and biologically plausible, but before this changes practice, we need OS data and international validation (this was China high-volume centers only). nejm.org/doi/full/10.10…

Dr. Kleinhenz et al describe a case of treatment of FGFR2 fusion-positive biliary tract cancer with lenvatinib after progression on pemigatinib and futibatinib. @susanebates @gbanna74 @PasRescigno @SebLange doi.org/10.1093/oncolo…

New online! Perioperative approaches for patients with biliary tract cancer dlvr.it/TRGQ02

Excellent review👏by @shimulshah73 & team #transplantoncology #cholangiocarcinoma It is great to see how prior therapies evolve in the developing landscape of drug discovery. Now need to find optimal treatment sequence so as to not🔥🌉maybe with🧬profile @OHSUKnight @curecc

New @NatureComms study by @NeehaZaidi, reiterating what has also been shown with mRNA & amphiphilic peptide vaccines - it IS possible to generate long lasting tumor antigen specific T cell responses against #PancreaticCancer in the postoperative setting. nature.com/articles/s4146…

💊 CAPE dosing: black box? 🧬 FDA: mandatory DPYD testing ⚠️ Complete DPD def. → avoid ❓ Partial def. (~5%) → individualize 📉 25–50% dose reduction? Limited evidence 📊 PK/PD very variable (renal, sex, surgery…) 🎯 Efficacy–exposure relation unclear 👉 Time to rethink CAPE dosing. 🔗 doi.org/10.1200/JCO-25…

Barcelona HCC classification may not reflect current treatment practices in US The new BEACON-HCC Classification was introduced for comment today @HCCLIVEConf - pls weigh in! Pilot real-world cases: Expert concordance 100% with BEACON-HCC vs 58.6% with 2022 #BCLC

The role of stereotactic body radiotherapy in the management of HCC with macroscopic vascular invasion: a narrative review doi.org/10.1016/j.esmo… 👏excellent review 👉SBRT emerges as a crucial tool in the multidisciplinary management of HCC and has the potential to enhance systemic therapy efficacy @myESMO @ASCO @EASLnews @ILCAnews

⭕️Liver-Directed Therapy for Colorectal Cancer: Where Are We Now? ⁦⁦@ASCO⁩ Educational Book ⁦@OncoAlert⁩ ascopubs.org/doi/pdf/10.120…

🟤MSI-H non-CRC GI cancers @myESMO ✅A review of current data and future directions 👉esmogastro.org/article/S2949-… #cancer #oncology #MedX #GI #immunotherapy @OncoAlert @realbowtiedoc

Nivolumab plus ipilimumab vs lenvatinib or sorafenib as first-line treatment for HCC: 4-year follow-up of CheckMate 9DW #ASCOGI26 👉ORR: 36 vs 13% 👉mOS: 23.7 vs 20.6 mo 🧐 Very valid option in HCC; Hepatic IMAEs need to be observed @myesmo @ASCO @EASLedu @ILCAnews

🟫1L mFOLFOXIRI-Panitumumab vs mFOLFOX-Panitumumab in mCRC 5y results of TRIPLETE @JCO_ASCO ✅mOS: 41.1 vs 33.3 mo HR: 0.79 [0.63 to 0.99]; P = .049 👉ascopubs.org/doi/10.1200/JC… #cancer #oncology #MedX #GI26 @OncoAlert @GIMedOnc

ASCO GI is coming! Not exhaustive, not a ranking. Just a quick snapshot of orals and posters I’m circling as I walk the halls. A mix of practice-shaping data and signals of where the field is heading 👇 🟦 Ab 283. CRITICS-II. Neoadjuvant chemo vs chemo + RT vs RT alone in resectable gastric cancer. Pairs nicely with ESOPEC. ESOPEC showed perioperative FLOT beat preop chemoradiation (CROSS). CRITICS-II shows adding radiation to perioperative chemo adds no survival benefit. Together, these trials likely suggest a shrinking role for radiation and reinforce perioperative chemo, especially FLOT, as the backbone. 🟦 Ab LBA284. ILUSTRO. Zolbetuximab + mFOLFOX6 + nivolumab in CLDN18.2+ gastric/GEJ cancer. CLDN18.2 is real, but zolbetuximab toxicity remains an issue. GLOW paired it with CAPEOX and no IO; this adds immunotherapy. Key question is whether efficacy can outpace tolerability or whether we need better ways to hit this target. 🟦 HERIZONGEA-01. Zanidatamab + chemo ± tislelizumab in 1L HER2+ GEA. Bring on the bispecifics 🔥 After years of incremental HER2 gains, dual-epitope targeting feels like the first real step forward. Can this finally move the needle meaningfully in 1L? 🟦 Ab 18. GLP-1 receptor agonist vs aspirin for primary CRC prevention. Ooo. GLP-1 vs aspirin 👀 We keep hearing GLP-1s cause cancer. This asks the opposite question using real-world data. Metabolism, inflammation, and CRC risk colliding in an interesting way. 🟦 Ab 20. Liver transplantation for unresectable CRLM. Belgian real-world data. TRANSMET changed the game. Now the question is durability and scalability outside trials. Selection, recurrence patterns, and real-world outcomes matter more than ever. 🟦 Ab 14. COMMIT. Atezo vs mFOLFOX/bev/atezo in 1L MSI-H metastatic CRC. CHECKMATE-8HW suggested dual IO beats single-agent. More randomized data nudging us away from chemo for MSI-H disease is welcome, especially for patients who may never need it. 🟦 Ab TPS265. Telisotuzumab adizutecan vs SOC in post-adjuvant ctDNA+ CRC. Phase III on deck. ctDNA-defined MRD is clearly the next battleground. The key question is how big the benefit needs to be to change adjuvant practice. 🟦 Ab TPS266. EpCAM × 4-1BB bsAb + PD-L1 × VEGF bsAb + chemo in mCRC. The bispecifics are multiplying 😅 Two bispecifics. Four targets. One trial. Ambitious, complex, and very on-trend for MSS CRC immunotherapy. 🟦 Ab TPS275. TROP2 CAR IL-15–engineered cord blood NK cells + cetuximab in CRC MRD. MRD studies everywhere, but adding cellular therapy makes this one stand out. If immune escalation is going to work, minimal disease is the place to try it. 🟦 Ab TPS273. BXQ-350 + mFOLFOX7/bev in 1L metastatic CRC. First-line phase 1 with a new mechanism targeting sphingolipid metabolism. Early, but exactly the kind of biology-driven swing worth watching. 🟦 Ab 297. Peritoneal metastasis as an exclusion criterion in GI cancer trials. Gut Onc Lab work 🙌 Shows how eligibility criteria have tightened over time, often excluding patients with peritoneal disease. Big implications for generalizability and equity. Fun writing the code for this effort. That’s the start of my early ASCO GI hit list. I’ll inevitably miss something great. If there’s an abstract I should see, let me know in the comments or stop me in the hallway 👋 #GI26 @OncoAlert @TheGutOncLab

Same labs. Different toxicity. CTCAE v6.0 changes how we grade cytopenias. This matters if you run clinical trials. CTCAE drives DLTs, dose holds, and how safety signals are interpreted. Small threshold changes can meaningfully alter trial results. What changed in v6.0 vs v5.0 Big picture Overall downgrading. Many lab values that used to be called Grade 3 or 4 are now lower grade, and this better reflects clinical practice. Neutropenia ANC 1000 to 1500 is now Grade 1 (was Grade 2). The old Grade 1 gone (poof). Grade 4 is stricter with a cutoff of less than 100 (previously less than 500). Thrombocytopenia Grade 3 is wider at 10k to 50k (previously 25k to 50k). Grade 4 is stricter at less than 10k (previously less than 25k). Bottom line Expect fewer high grade cytopenias on paper even if the drug is the same. Be careful comparing new trials to older data. This is closer to how we actually take care of patients. Either way, as an investigator, this is a fantastic change.

🔥off the press🔥 Navigating second-line therapy after immunotherapy in advanced HCC @JHEP_Reports doi.org/10.1016/j.jhep… 👉Our thoughts on second line therapy in HCC 🧐Much progress in 1st line, more trials in 2nd line needed @myESMO @EASLedu @ILCAnews

Precision-Guided Durable Response From Venetoclax With Decitabine in a Patient With a Metastatic Refractory IDH2-Mutant Cholangiocarcinoma | JCO Precision Oncology ascopubs.org/doi/10.1200/PO…