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GI ASCO 2025 Highlights - BREAKWATER, CheckMate-8HW, ALASCCA, STARTER-NET


Keypoints:

alok-khorana-md-cleveland-oh

1. BREAKWATER: We explore the implications of using Encorafenib and Cetuximab in combination with FOLFOX for patients with BRAF V600E mutations, which are associated with poor prognosis.
2. CheckMate-8HW: This study investigates whether dual checkpoint inhibition is more effective than single-agent immunotherapy for MSI-high patients, revealing promising results in progression-free survival.
3. Aspirin in Adjuvant Settings: We discuss the role of low-dose aspirin in reducing recurrence rates for patients with PI3K alterations, highlighting its potential as a practice-changing intervention.
4. STARTER-NET: Finally, we review the findings from the study on Everolimus combined with Lanreotide for neuroendocrine tumors, noting the lack of overall survival benefit.

In this episode of the Oncology Brothers podcast, hosts Drs. Rahul & Rohit Gosain had the pleasure of hosting Dr. Alok Khorana, a GI medical oncologist from the Cleveland Clinic, who shared his insights on key studies presented at the GI ASCO 2025 conference.

We began by discussing the BREAKWATER study, which focuses on patients with the BRAF V600E mutation in metastatic colorectal cancer. Dr. Khorana emphasized the importance of using aggressive upfront therapy, specifically the combination of Encorafenib and Cetuximab with FOLFOX, which has shown significant improvements in overall response rates and is set to become the new standard of care for this patient population.

Next, we delved into the CheckMate 8HW study, which explored the efficacy of dual checkpoint inhibition in MSI-high colorectal cancer. Dr. Khorana highlighted the impressive progression-free survival (PFS) results with the combination of Nivolumab and Ipilimumab compared to Nivolumab alone, suggesting a potential shift in treatment strategies for this subset of patients.

We also discussed the role of aspirin in the adjuvant setting for patients with PI3K alterations. Dr. Khorana presented compelling data showing that low-dose aspirin significantly reduces the risk of recurrence in these patients, making it a practice-changing consideration for oncologists.

Finally, we touched on the STARTER-NET study, which investigated the combination of Lanreotide and Everolimus in non-functional unresectable metastatic neuroendocrine tumors. While the study showed improved PFS, Dr. Khorana expressed caution in making practice changes based solely on this data, as overall survival results were not yet available.

In summary, this episode provided valuable insights into the latest advancements in colorectal cancer treatment and the implications for clinical practice. We encourage our listeners to stay informed about these developments and consider how they might apply them in their own practices. Thank you for joining us, and be sure to check out our other episodes for more discussions on oncology topics!

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