ESMO Gastrointestinal Oncology最新文献

{"title":"Single-system outcomes after adopting yttrium-90 radioembolization with personalized dosimetry as the primary treatment approach for unresectable, solitary hepatocellular carcinoma","authors":"A. Zamani ,&nbsp;K. Núñez ,&nbsp;T. Sandow ,&nbsp;J. Gimenez ,&nbsp;A. Cohen ,&nbsp;P. Thevenot","doi":"10.1016/j.esmogo.2026.100309","DOIUrl":"10.1016/j.esmogo.2026.100309","url":null,"abstract":"<div><h3>Background</h3><div>Yittrium-90 (⁹⁰Y) radioembolization has emerged as a secondary treatment option for early- to intermediate-stage hepatocellular carcinoma (HCC) in the Barcelona Clinic Liver Cancer (BCLC) Staging and Treatment Algorithm. Several trials have recently shown that ⁹⁰Y is a safe and effective primary treatment option for BCLC stages A and B. In this study, the outcomes for three treatment centers within a single health system with experience utilizing ⁹⁰Y as a definitive treatment option for early-stage HCC (BCLC-A) were analyzed in the context of results reported by the DOSISPHERE-01 and TARGET clinical trials.</div></div><div><h3>Materials and methods</h3><div>The cohort was derived from multiple treatment centers within a single health system that utilized ⁹⁰Y as the primary option for BCLC-A solitary, unresectable HCC &gt;3 cm and as a secondary option for HCC &lt;3 cm, both with an Eastern Cooperative Oncology Group score of 0-1 and Child–Pugh A5-B9 (<em>n</em> = 171, 2018-2024). The study outcomes included first-cycle objective response (OR) and complete response (CR) rates, target time to retreatment (tTTR), time to BCLC-C progression, progression-free survival (PFS), and overall survival (OS).</div></div><div><h3>Results</h3><div>Patients were enrolled between 2018 and 2024 (<em>n</em> = 171). OS rates at 1 and 3 years were 94% and 73%, with 1- and 3-year PFS rates of 89% and 61%, respectively. Response to first-cycle ⁹⁰Y could be assessed in 166 patients. The overall OR rate was 98% (163/166), with 71% (118/166) achieving a target CR. Patients who obtained a target CR had reduced progression rates at 1 year (2% versus 16%) and 3 years (21% versus 62%) compared with incomplete responders. The median tTTR in patients who achieved a target CR was 48 months, with 1- and 2-year retreatment rates of 9% and 24%, respectively.</div></div><div><h3>Conclusion</h3><div>First-cycle ⁹⁰Y radioembolization with personalized dosimetry is an effective treatment option for early-stage, solitary HCC that yields high, sustained response rates.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"11 ","pages":"Article 100309"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review of established and new developments in local therapies for liver cancer","authors":"P. Seda ,&nbsp;R. Abbey ,&nbsp;L. Peng ,&nbsp;I. Ezeaku ,&nbsp;S.T. Laroia ,&nbsp;H. Aziz","doi":"10.1016/j.esmogo.2025.100283","DOIUrl":"10.1016/j.esmogo.2025.100283","url":null,"abstract":"<div><div>Liver cancer, especially hepatocellular carcinoma (HCC), which accounts for ∼75%-85% of primary liver cancers, remains a major global health challenge. Because of its high incidence, late diagnosis, and limited curative options, local therapies have become increasingly popular for the multidisciplinary management of HCC, especially in early and intermediate Barcelona Clinic Liver Cancer stages or in medically inoperable patients. This review examines a landscape of local treatment modalities for HCC encompassing radiofrequency ablation, microwave ablation, cryoablation, irreversible electroporation, histotripsy, transarterial chemoembolization, transarterial radioembolization, and stereotactic body radiotherapy. We also highlight their respective advantages and disadvantages, compare their survival outcomes, and identify current gaps in the literature, including the need for further comparisons between safety profiles and efficacy, and the growing landscape that is using different local therapies in a sequential or combinatorial fashion. Emphasis is placed on treatment decisions tailored to tumor burden, liver function, and patient-specific considerations. Expanding access to advanced local therapies in resource-limited settings remains a global priority.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"11 ","pages":"Article 100283"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preference versus protocol: oncology clinicians’ perspectives on central venous access for administration of chemotherapy in pancreatic cancer","authors":"M.U.J.E. Graus ,&nbsp;R.A.L. Willems ,&nbsp;N.C. Biesma ,&nbsp;A.J. de Wilde ,&nbsp;F.W.P.J. van den Berkmortel ,&nbsp;S.A.W. Bouwense ,&nbsp;G.A. Cirkel ,&nbsp;M.Y.V. Homs ,&nbsp;E. Jellema-Betten ,&nbsp;N. Pepels-Aarts ,&nbsp;H.C. van Santvoort ,&nbsp;E.C.J. van Vliet ,&nbsp;M.L. Wumkes ,&nbsp;J.W. Wilmink ,&nbsp;I.H.J.T. de Hingh ,&nbsp;L.B.J. Valkenburg-van Iersel ,&nbsp;J. de Vos-Geelen ,&nbsp;Dutch Pancreatic Cancer Group","doi":"10.1016/j.esmogo.2026.100311","DOIUrl":"10.1016/j.esmogo.2026.100311","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic cancer treatment significantly impacts patients’ quality of life, making both safety and patient preference key considerations. Central venous access devices (CVADs) are indispensable for chemotherapy administration in pancreatic cancer, yet device selection varies widely. This study explored which CVADs oncology specialists use in pancreatic cancer care, focusing on the basis for their recommendations.</div></div><div><h3>Materials and methods</h3><div>A nationwide expert survey was distributed among Dutch medical oncologists and nurse specialists involved in pancreatic cancer care via the Dutch Pancreatic Cancer Group, the Dutch Association for Medical Oncology, the Dutch association for nurses, and the study committee’s network.</div></div><div><h3>Results</h3><div>Ninety-one clinicians responded. Most (88%) had access to both port-a-caths (PORTs) and peripherally inserted central catheters (PICCs), while 12% could only offer one device. Decision-making autonomy varied: 53% reported full autonomy, while others followed hospital-wide preferences (39%) or guidelines (9%). Even within these subgroups, preferred CVAD varied greatly. Although 60% listed patient preference among the top five influential factors, only 28% incorporated patients in that decision. Logistical constraints were key barriers influencing device choice.</div></div><div><h3>Conclusion</h3><div>Substantial variability exists in CVAD selection, availability, and clinician autonomy in pancreatic cancer care. While evidence supports PORTs as the safer option, PICCs remain widely used in daily practice. This discrepancy appears driven by disease-specific and logistical factors, including poor prognosis and uncertainty regarding treatment tolerance. Addressing real-world barriers through improved access to PORTs, clearer guideline recommendations, and enhanced patient counseling may help align clinical practice with evidence and ensure high-quality care for patients receiving chemotherapy.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"11 ","pages":"Article 100311"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147421004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ESMO podcast on upper GI cancers: highlights in hepatocellular carcinoma and pancreatic cancer from ESMO 2025","authors":"J. Dekervel ,&nbsp;A. Vogel ,&nbsp;E. O’Reilly","doi":"10.1016/j.esmogo.2025.100277","DOIUrl":"10.1016/j.esmogo.2025.100277","url":null,"abstract":"","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"11 ","pages":"Article 100277"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health-related quality of life in biliary tract cancer clinical trials. The current state and future directions","authors":"L. Cavka ,&nbsp;J. Edeline ,&nbsp;A. Lamarca","doi":"10.1016/j.esmogo.2026.100301","DOIUrl":"10.1016/j.esmogo.2026.100301","url":null,"abstract":"<div><h3>Background</h3><div>Patients with biliary tract cancers (BTCs) often experience a decline in health-related quality of life (HRQoL). Patient-reported outcome measures (PROMs), usually collected through HRQoL questionnaires, offer a standardized approach to capturing the patient’s perspective. This study aimed to provide a comprehensive analysis of HRQoL in BTC clinical trials.</div></div><div><h3>Design</h3><div>After database screening, the 30 most impactful clinical trials in BTC were identified for evaluation of HRQoL reporting and analysis. The primary objective was to determine the proportion of trials that included HRQoL assessment. Secondary objectives were to examine different aspects of HRQoL analysis and to assess the robustness of reporting using the recently developed European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS) HRQoL checklist.</div></div><div><h3>Results</h3><div>Fifteen trials (50%) included HRQoL in their design, with published results available for 14. The most frequent HRQoL outcome was stability (i.e. neither improvement nor deterioration). The median ESMO-MCBS HRQoL checklist score was 11 (interquartile range 9.00-11.75).</div></div><div><h3>Conclusions</h3><div>HRQoL remains only partially addressed in BTC clinical trials. Tools such as the ESMO HRQoL checklist and electronic PROMs may strengthen the assessment and highlight the importance of HRQoL in both clinical trials and routine practice.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"11 ","pages":"Article 100301"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathologic correlates of claudin 18.2 expression in esophagogastric cancer at multiple expression levels","authors":"C.H. Maeng ,&nbsp;A. Alkashash ,&nbsp;A. Sy ,&nbsp;H. Barnes ,&nbsp;S. Bannon ,&nbsp;C. Simms ,&nbsp;M.R. Strickland ,&nbsp;J.N. Glickman ,&nbsp;S.J. Klempner","doi":"10.1016/j.esmogo.2025.100278","DOIUrl":"10.1016/j.esmogo.2025.100278","url":null,"abstract":"<div><h3>Background</h3><div>Claudin-18 isoform 2 (CLDN18.2) is a validated therapeutic target in gastric cancer (GC) and gastroesophageal junction cancer (GEJ). The approved antibody zolbetuximab requires higher expression levels (≥75% of tumor cells with 2-3+ membranous staining), yet broader thresholds are increasingly explored. Data on clinicopathologic correlates and biomarker overlap at lower cut-offs remain limited.</div></div><div><h3>Patients and methods</h3><div>We retrospectively analyzed patients with esophageal cancer (EC), GEJ, or GC who underwent CLDN18.2 immunohistochemistry at a single high-volume center (2023-2025). CLDN18.2 positivity was defined using three thresholds: (i) stringent (<em>75% threshold</em>: ≥75% of tumor cells with 2-3+ staining); (ii) broader (<em>H-score 25</em>; ≥1+ intensity in ≥25% of cells); and (iii) the lowest (<em>H-score 10</em>; ≥1+ intensity in ≥10% of cells). Associations between CLDN18.2 and clinicopathologic variables, including histology and standard biomarkers [human epidermal growth factor receptor 2 (HER2), programmed death-ligand 1 (PD-L1), and mismatch repair (MMR)], were assessed.</div></div><div><h3>Results</h3><div>In total, 149 patients were included: 43 EC (28.9%), 46 GEJ (30.9%), and 60 GC (40.3%). CLDN18.2 positivity rates were 48.3%, 71.1%, and 73.8% at the <em>75%</em>, <em>H-score 25</em>, and <em>H-score 10</em> thresholds, respectively. CLDN18.2 positivity significantly correlated with tumor location, highest in GC and followed by GEJ and EC across thresholds. At the lowest cut-off, positivity was 85.0% in GC, 69.6% in GEJ, and 62.8% in EC (<em>P</em> = 0.030). Histological subtypes were also associated across thresholds: poorly cohesive carcinoma (PCC) demonstrated significantly higher positivity than non-PCC. No significant associations were found with HER2, PD-L1 combined positive score, or MMR. Triple positivity for CLDN18.2, HER2, and PD-L1 was rare (≤5.5%).</div></div><div><h3>Conclusion</h3><div>CLDN18.2 expression in upper gastrointestinal cancers was significantly associated with gastric origin and PCC histology, independent of HER2 and PD-L1 status. Broadening the threshold for positivity identified nearly three-quarters of patients as CLDN18.2 positive, underscoring the impact of selection cut points on trial eligibility. These findings highlight the potential to expand patient access to CLDN18.2-targeted therapies using lower thresholds.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"11 ","pages":"Article 100278"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of stereotactic body radiotherapy in the management of hepatocellular carcinoma with macroscopic vascular invasion: a narrative review","authors":"I.J. Gerard ,&nbsp;A.M. Glynn ,&nbsp;M.D. Faye ,&nbsp;M. Yan ,&nbsp;A. Mesci ,&nbsp;T.K. Kim ,&nbsp;R. Vanner ,&nbsp;L.A. Dawson","doi":"10.1016/j.esmogo.2025.100298","DOIUrl":"10.1016/j.esmogo.2025.100298","url":null,"abstract":"<div><div>Hepatocellular carcinoma (HCC) is the most common primary liver cancer, with a rising global incidence. Prognosis in HCC remains poor, particularly in patients presenting with macrovascular invasion (MVI), which is associated with high rates of hepatic decompensation, diffuse disease progression, and a median survival of only 2-5 months without treatment. Management of HCC with MVI is complex, requiring multidisciplinary and multimodality approaches. While surgery and transplantation may be considered in select cases, systemic therapy with immunotherapy-based regimens currently represents standard of care. Limitations due to complications with MVI often makes optimal treatment challenging. Advances in modern radiotherapy, particularly stereotactic body radiotherapy (SBRT), have established it as a safe and effective local therapy capable of delivering ablative doses while sparing normal liver tissue. Retrospective series and prospective trials have demonstrated that SBRT provides high local control rates, objective response rates exceeding 50%, and survival benefits when combined with systemic or locoregional therapies alone. SBRT has also shown promise in improving liver function and palliating symptoms in patients with poor hepatic reserve. Emerging evidence suggests synergistic effects when combined with immunotherapy or transarterial therapies, with ongoing studies poised to clarify its role in modern treatment paradigms. Collectively, data support the use of SBRT as a crucial tool in the multidisciplinary management of HCC with MVI, offering durable local control, symptom relief, and the potential to enhance systemic therapy efficacy.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"11 ","pages":"Article 100298"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fruquintinib in combination with tislelizumab versus trifluridine/tipiracil and bevacizumab in third-line and beyond MSS mCRC without active liver metastases—the IKF-080/AIO-QUINTIS trial","authors":"J. Tintelnot ,&nbsp;J. Gorgulho ,&nbsp;S.-E. Al-Batran ,&nbsp;D. Arnold ,&nbsp;A. Reinacher-Schick ,&nbsp;S. Kasper ,&nbsp;G. Prager ,&nbsp;T. Goetze ,&nbsp;R. Boston ,&nbsp;M.S. Cruz ,&nbsp;F. Dierks ,&nbsp;A. Stein","doi":"10.1016/j.esmogo.2026.100312","DOIUrl":"10.1016/j.esmogo.2026.100312","url":null,"abstract":"<div><h3>Background</h3><div>Patients with metastatic colorectal cancer (mCRC) who have progressed on fluoropyrimidines, oxaliplatin, irinotecan, anti-angiogenic agents, and anti-epidermal growth factor receptor (EGFR) therapies have limited treatment options and poor prognosis, with a median overall survival (mOS) of ∼6 months on single-agent regorafenib or trifluridine/tipiracil. The addition of bevacizumab to trifluridine/tipiracil improved mOS to 10.8 months, and fruquintinib, a selective vascular endothelial growth factor receptor (VEGFR) 1-3 inhibitor, improved mOS to 7.4 months versus 4.8 months with placebo in refractory mCRC. However, combinations of tyrosine kinase inhibitors and immune checkpoint inhibitors have shown benefit primarily in patients without liver metastases in microsatellite stable mCRC, likely due to liver-associated immunosuppression. The QUINTIS trial evaluates whether fruquintinib plus tislelizumab can improve outcomes to the standard of care with trifluridine/tipiracil and bevacizumab in third-line and beyond mCRC.</div></div><div><h3>Methods/design</h3><div>QUINTIS is a prospective, randomized, open-label, multicenter, phase II trial enrolling patients with advanced or metastatic colorectal adenocarcinoma without active liver metastases who have been previously treated with fluoropyrimidines, oxaliplatin, irinotecan, bevacizumab, and, if indicated, an EGFR inhibitor. Participants are randomly assigned 1 : 1 to one of the following treatment arms: arm A (experimental): fruquintinib 5 mg orally once daily on days 1-21 of a 4-week cycle (q4w) plus tislelizumab 400 mg intravenously on day 1 every 6 weeks (q6w); or arm B (control): trifluridine/tipiracil 35 mg/m² orally twice daily on days 1-5 and 8-12 of a 4-week cycle (q4w) plus bevacizumab 5 mg/kg intravenously on day 1 every 2 weeks (q2w). Randomization is stratified by prior anti-angiogenic therapy (&lt;12 versus ≥12 months ago), <em>BRAF</em>/<em>RAS</em> mutation status, and history of liver metastases (never versus treated). Tumor assessments occur every 8 weeks; follow-up continues for up to 18 months after enrolment. Optional translational research includes tumor, blood, and stool sampling to explore biomarkers of response and resistance.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"11 ","pages":"Article 100312"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147421127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stereotactic body radiotherapy in early-stage hepatocellular carcinoma: a systematic review and meta-analysis","authors":"J.K. van Vulpen ,&nbsp;M.C. Verwijs ,&nbsp;F.K. Gommers ,&nbsp;R.A.H. van Eijck van Heslinga ,&nbsp;S. van Meer ,&nbsp;C.J.R. Verstraete ,&nbsp;J. Hagendoorn ,&nbsp;M.G.E.H. Lam ,&nbsp;N. Haj Mohammad ,&nbsp;M.L.J. Smits ,&nbsp;M.N.G.J.A. Braat ,&nbsp;M.P.W. Intven ,&nbsp;J. de Bruijne","doi":"10.1016/j.esmogo.2025.100281","DOIUrl":"10.1016/j.esmogo.2025.100281","url":null,"abstract":"<div><h3>Background</h3><div>First-line treatment strategies for (very) early-stage hepatocellular carcinoma (HCC) include liver transplantation, surgical resection and thermal ablation. Stereotactic body radiotherapy (SBRT) has recently been included in the European Association for the Study of the Liver Clinical Practice Guidelines on the management of hepatocellular carcinoma as an alternative ablative strategy. We aimed to carry out a systematic review and meta-analysis on oncological outcomes and toxicity of SBRT focused on early-stage HCC treatment.</div></div><div><h3>Materials and methods</h3><div>We carried out a systematic literature search in PubMed, Embase, and the Cochrane Library from inception throughout October 2022. Studies of SBRT targeting treatment-naive (very) early-stage HCC (BCLC 0/A) patients were included.</div></div><div><h3>Results</h3><div>One prospective and 15 retrospective studies were included in this review. In aggregate, SBRT in 1249 patients resulted in a 1-, 2-, and 3-year local control rate of 94% (95% CI 92%-97%), 89% (95% CI 85%-93%), and 79% (95% CI 68%-90%), respectively. The pooled results of the 1-, 2-, and 3-year overall survival rate were 90% (95% CI 85%-94%), 75% (95% CI 63%-87%), and 59% (95% CI 45%-73%), respectively. Grade ≥3 toxicity was observed in 2% of patients (95% CI 0%-4%).</div></div><div><h3>Conclusion</h3><div>This systematic review and meta-analysis showed that SBRT is an effective and safe treatment modality for treatment-naive patients with early-stage HCC. The data support incorporation of SBRT as a treatment option in the treatment algorithms for (very) early-stage HCC.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"11 ","pages":"Article 100281"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment attrition between lines of therapy and its impact on outcomes for well-differentiated neuroendocrine tumors in British Columbia","authors":"R. Fedrigo ,&nbsp;T. do Amaral Miranda ,&nbsp;R. D’Alpino Peioxoto ,&nbsp;S. Gill ,&nbsp;F. Benard ,&nbsp;D. Wilson ,&nbsp;P. Martineau ,&nbsp;I. Alberts ,&nbsp;J.P. Solar Vasconcelos ,&nbsp;J.M. Loree","doi":"10.1016/j.esmogo.2026.100305","DOIUrl":"10.1016/j.esmogo.2026.100305","url":null,"abstract":"<div><h3>Background</h3><div>Neuroendocrine neoplasms are uncommon malignancies with variable prognosis. With a growing number of available therapies and recent data supporting earlier initiation of radioligand therapy, we aimed to characterize attrition between lines of therapy to inform treatment sequencing and establish baseline assumptions for future health technology assessments.</div></div><div><h3>Patients and methods</h3><div>In this retrospective chart review, patients with metastatic gastroenteropancreatic neuroendocrine tumors (NETs) who received one or more systemic therapies from January 2010 to December 2023 were reviewed. The primary endpoint was attrition between treatment lines. Logistic regression model was used to identify predictors of attrition.</div></div><div><h3>Results</h3><div>Among 234 patients, 65 (28%) had pancreatic NETs (pNETs) and 169 (72%) had extra-pancreatic gastrointestinal NETs (ep-GI-NETs); median age at diagnosis was 65 years. Maximum number of treatment lines was six for pNETs and four for ep-GI-NETs. First-to-second-line attrition rates were 22% [95% confidence interval (CI) 13% to 36%] and 34% (95% CI 25% to 44%) for pNETs and ep-GI-NETs, respectively. Somatostatin analogs were the preferred first line in 194 patients (83%). Peptide receptor radionuclide therapy was administered to 13 pNETs (20%) and 42 ep-GI-NETs (25%). Median first-line progression-free survival (PFS) was 8.8 months and 26.1 months for pNETs and ep-GI-NETs, respectively. Patients treated in the latter cohort (2021-2023) had a lower risk of attrition compared with those in the earlier cohort (2010-2020) (odds ratio 0.38, 95% CI 0.14-0.94, <em>P</em> = 0.046).</div></div><div><h3>Conclusions</h3><div>Despite longer first-line PFS, patients with ep-GI-NETs faced higher attrition rates. These findings emphasize the need to prioritize the most effective therapies early during treatment sequencing to ensure patients are exposed to the most active agents.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"11 ","pages":"Article 100305"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}