Oncology Brothers: Practice-Changing Cancer Discussions GI Cancer ESMO 2025 Highlights: DYNAMIC-III, PEGASUS, STELLAR-303, MATTERHORN, FORTITUDE-101
Nov 3, 2025
Dr. Rachna Shroff, a GI medical oncologist at the University of Arizona, shares her insights on groundbreaking gastrointestinal oncology data from ESMO 2025. She dives into the potential of ctDNA as a prognostic tool in early-stage colon cancer, and discusses the promising outcomes of immunotherapy for refractory colorectal cancer. The conversation highlights how combining durvalumab with FLOT could redefine upper GI cancer treatment and explores the implications of targeting FGFR2b in metastatic conditions. A must-listen for oncology enthusiasts!
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ctDNA Is Prognostic, Not Proven Predictive
- DYNAMIC-III shows ctDNA positivity after resection is prognostic but not yet predictive for guiding adjuvant escalation.
- Escalating therapy based on ctDNA did not improve two-year recurrence-free survival versus standard care in stage III colon cancer.
PEGASUS Confirms Feasibility, Not Definitive Action
- PEGASUS confirmed feasibility but had small numbers and no definitive practice-changing result for ctDNA-guided therapy.
- ctDNA positive patients had worse DFS, but the trial doesn't support routine therapy changes outside trials.
Reserve ctDNA For Trials, Don’t Change Adjuvant Care Yet
- Use ctDNA primarily within clinical trials for stratification and research until predictive value is proven.
- Avoid using ctDNA alone to decide adjuvant type, duration, or post-adjuvant therapy in routine practice.