ESMO Gastrointestinal Oncology最新文献

{"title":"Durvalumab plus gemcitabine-cisplatin versus S-1 plus gemcitabine-cisplatin in advanced biliary tract cancer: a comparative study","authors":"T. Satake,&nbsp;M. Sasaki,&nbsp;H. Imaoka,&nbsp;S. Taro,&nbsp;K. Inoue,&nbsp;T. Taira,&nbsp;G. Igarashi,&nbsp;M. Amisaki,&nbsp;H. Takahashi,&nbsp;S. Mitsunaga,&nbsp;M. Ikeda","doi":"10.1016/j.esmogo.2025.100265","DOIUrl":"10.1016/j.esmogo.2025.100265","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Following the TOPAZ-1 trial, chemoimmunotherapy with durvalumab plus gemcitabine and cisplatin (GCD) became the standard first-line treatment of advanced biliary tract cancer (BTC). This study aimed to compare the therapeutic efficacy of GCD and gemcitabine, cisplatin, and S-1 (GCS).</div></div><div><h3>Methods</h3><div>This single-center, retrospective study consecutively included patients with advanced BTC receiving primary treatment with GCD or GCS between November 2018 and August 2024.</div></div><div><h3>Results</h3><div>A total 265 patients with advanced BTC were included: 97 were treated with GCD and 168 were treated with GCS. Median overall survival (OS) was 17.1 months [95% confidence interval (CI) 12.7-20.6 months] in the GCD group versus 18.3 months (95% CI 15.4-20.4 months) in the GCS group, with no statistically significant difference (<em>P</em> = 0.509). Median progression-free survival (PFS) was 8.0 months (95% CI 5.9-9.6 months) in the GCD group versus 8.9 months (95% CI 7.1-11.4 months) in the GCS group (<em>P</em> = 0.077). No differences were noted in objective response rates, whereas median duration of response (DoR) was significantly longer in the GCS group (12.7 months) than that in the GCD group (7.5 months) (<em>P</em> = 0.022). Patients with <em>ARID1A</em> or <em>PIK3CA</em> alterations, or with <em>SMAD4</em> wild-type, had better OS with GCS than with GCD.</div></div><div><h3>Conclusion</h3><div>GCD and GCS provide comparable survival outcomes and safety in clinical practice, with a significantly longer DoR in the GCS group. Alongside GCD, GCS represents one of the standard treatment options for advanced BTC.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"10 ","pages":"Article 100265"},"PeriodicalIF":0.0,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578864","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":"Circulating tumor DNA as a predictor of response and prognosis in rectal cancer treated with total neoadjuvant therapy (JCOG2010A1-ctTNT study)","authors":"T. Hashimoto ,&nbsp;H. Hirano ,&nbsp;A. Takashima ,&nbsp;S. Sekine ,&nbsp;K. Kanato ,&nbsp;J. Mizusawa ,&nbsp;H. Fukuda ,&nbsp;S. Tsukamoto ,&nbsp;Y. Kanemitsu","doi":"10.1016/j.esmogo.2025.100212","DOIUrl":"10.1016/j.esmogo.2025.100212","url":null,"abstract":"<div><div>JCOG2010A1 is a multi-institutional prospective observational study evaluating circulating tumor DNA (ctDNA) as a biomarker for minimal residual disease (MRD) detection in rectal cancer patients undergoing total neoadjuvant therapy (TNT) with active surveillance. This companion study to the JCOG2010 phase II/III trial addresses a critical clinical challenge: determining optimal treatment pathways between surgery and non-operative management following TNT. While TNT with active surveillance represents a promising organ-preserving strategy for patients achieving clinical complete response, reliable biomarkers for residual disease assessment remain lacking. ctDNA has emerged as a highly sensitive biomarker for MRD detection across multiple cancer types. The Signatera™ personalized tumor-informed assay will be utilized for ctDNA analysis throughout the treatment journey, potentially enabling more precise, individualized decision making.<ul><li><span>•</span><span><div>Collect baseline tumor tissue and blood samples, followed by serial plasma collection at predetermined timepoints throughout the protocol treatment period, including post-TNT assessment and during active surveillance.</div></span></li><li><span>•</span><span><div>Analyze ctDNA using the Signatera™ personalized tumor-informed assay to detect minimal residual disease after TNT, with results correlated to clinical and radiological findings.</div></span></li><li><span>•</span><span><div>Compare recurrence-free survival, organ preservation rates, and overall survival based on ctDNA status at multiple timepoints to assess its utility as a prognostic and predictive biomarker for treatment decision making.</div></span></li></ul></div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"10 ","pages":"Article 100212"},"PeriodicalIF":0.0,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528857","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":"Overview of the multidisciplinary team activity in patients with hepatocellular carcinoma and their survival outcomes","authors":"V. Guarini ,&nbsp;C. Garzòn ,&nbsp;D. Casado ,&nbsp;M. Casanova ,&nbsp;P. Villarejo ,&nbsp;I. Azinovic ,&nbsp;E. Crespo ,&nbsp;I. Fernandez ,&nbsp;M. Lopez ,&nbsp;M.M. de Bourio ,&nbsp;M. Moran ,&nbsp;M. Jimenez ,&nbsp;G. Medrano ,&nbsp;V. Castellano ,&nbsp;A. Lamarca","doi":"10.1016/j.esmogo.2025.100263","DOIUrl":"10.1016/j.esmogo.2025.100263","url":null,"abstract":"<div><h3>Background</h3><div>Hepatocellular carcinoma (HCC) is the most common primary liver cancer, with increasing incidence, morbidity, and mortality. Although viral aetiologies are declining, metabolic disorders are emerging as the leading cause. Given the growing range of therapeutic options, effective management of HCC requires a multidisciplinary approach.</div></div><div><h3>Patients and methods</h3><div>This retrospective study analysed patients with HCC who were discussed by a multidisciplinary team (MDT). The study aimed to describe patient characteristics, treatment recommendations, and survival outcomes, including progression-free survival (PFS) and overall survival (OS).</div></div><div><h3>Results</h3><div>A total of 134 patients were included, with a median age of 68.2 years. Most were male (84.3%) and had an Eastern Cooperative Oncology Group performance status of 1 (67.2%). The majority had early-stage disease (62.7% in Barcelona Clinic Liver Cancer stage 0-A) and multiple comorbidities. We identified that 65 (48.5%) patients were presented in the MDT once, while 69 (51.5%) patients were presented two or more times. The median number of discussions per patient was 2 (range 1-8). Most patients discussed more than once were those diagnosed with early-stage disease at initial presentation. Treatment varied by stage: local ablative therapy was used in 54.8% of early-stage patients, locoregional therapy (LRT) in 37.9% of intermediate stage patients, and systemic therapy in 37.9% of intermediate-stage and 57.1% of advanced-stage patients. The median OS for the full cohort was 20.89 months [95% confidence interval (CI) 16.26-26.78]. Among LRTs, the median PFS was 24.46 months (95% CI 7.93-35.34) for transarterial chemoembolization and 27.77 months (95% CI 4.46-not reached months) for transarterial radioembolization. For systemic therapy, the median PFS was 13.65 months (95% CI 5.36-not reached months) with atezolizumab-bevacizumab and 4.59 months (95% CI 3.01-not reached) with sorafenib.</div></div><div><h3>Conclusion</h3><div>The study underscores the value of MDT-driven management in HCC, facilitating individualized, stage-specific treatment decisions. Repeated MDT evaluations are crucial for guiding patient care throughout the disease course.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"10 ","pages":"Article 100263"},"PeriodicalIF":0.0,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528858","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 ablative radiotherapy (SABR) for liver metastases: where we currently stand","authors":"S.H.R. Kim,&nbsp;M.K. Harrison","doi":"10.1016/j.esmogo.2025.100264","DOIUrl":"10.1016/j.esmogo.2025.100264","url":null,"abstract":"<div><div>Stereotactic ablative radiotherapy (SABR), which is already used as the standard-of-care treatment in other cancers such as lung, is being increasingly used in the treatment of liver metastases in the oligometastatic setting in unresectable, pre-treated patients. Various phase I/II trials and retrospective series have demonstrated its efficacy in terms of local control (LC), progression-free and overall survival. Tumour characteristics of &lt;6 cm, &lt;3 tumours and absence of extrahepatic disease, and favourable histologies including colorectal, breast and renal primaries have been associated with favourable outcomes. Radiation dose is also important, with a biological effective dose ≥120 Gy giving optimal LC. To be determined in SABR is the exact dose and fractionation employed, which is variable without evidence from randomised controlled trials to date. The aforementioned trials have established that SABR is well-tolerated. In the short-term, it can cause gastrointestinal disturbances, transaminitis and radiation-induced liver disease. In the longer-term, gastrointestinal bleeding and bone fractures have been rarely reported, though follow-up periods for studies were limited. Other treatments such as radiofrequency ablation (RFA) and surgery are also standard-of-care. There have been no prospective randomised trials to date comparing these treatments. Smaller trials demonstrated no survival differences between SABR and RFA, though these studies favour better LC in SABR for larger tumours (&gt;3 cm). To summarise, SABR for liver metastases leads to good LC and survival and is well-tolerated, especially with favourable tumour characteristics. Prospective studies will need to help establish its exact role in comparison with other localised therapies.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"10 ","pages":"Article 100264"},"PeriodicalIF":0.0,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528859","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":"Distinct clinicopathological and survival profiles of CLDN18.2 and PD-L1 expression in advanced gastric cancer and gastroesophageal junction adenocarcinoma","authors":"D.R. Castillo ,&nbsp;M. Guo ,&nbsp;P. Shah ,&nbsp;M. Hazeltin ,&nbsp;D. Tai ,&nbsp;F. Al-Manaseer ,&nbsp;S. Mlamba ,&nbsp;D. Perez ,&nbsp;S. Yeremian ,&nbsp;S. Guzman ,&nbsp;R. Mannan ,&nbsp;C. Crook ,&nbsp;C. Lau ,&nbsp;N. Tawar ,&nbsp;G. Brar ,&nbsp;M. Raoof ,&nbsp;Y. Woo ,&nbsp;S.P. Wu ,&nbsp;D. Li","doi":"10.1016/j.esmogo.2025.100261","DOIUrl":"10.1016/j.esmogo.2025.100261","url":null,"abstract":"<div><h3>Background</h3><div>Claudin 18.2 (CLDN18.2)-targeted therapy and immune checkpoint blockade have transformed the frontline treatment landscape of gastric and gastroesophageal junction (GC/GEJ) cancers, marking a major advance in precision oncology. However, the optimal sequencing and integration of these biomarker-driven therapies remain undefined. A comprehensive evaluation of the relationship between CLDN18.2 and programmed death-ligand 1 (PD-L1) expression, along with co-occurring genomic alterations and metastatic patterns, is critical to refine patient selection and improve survival outcomes.</div></div><div><h3>Materials and methods</h3><div>We retrospectively analyzed 70 patients with microsatellite-stable, human epidermal growth factor receptor 2 (HER2)-negative metastatic GC/GEJ adenocarcinoma treated with first-line chemoimmunotherapy. CLDN18.2 positivity was defined as ≥75% of tumor cells with moderate to strong membranous staining, and PD-L1 positivity as a combined positive score (CPS) ≥1. Molecular profiling of pretreatment tumor biopsies was carried out using a hybrid DNA/RNA sequencing panel covering 720 cancer-related genes. The incidence of key genomic alterations (<em>TP53, KRAS, CDH1, PIK3CA, RHOA, POLE, and CLDN18–ARHGAP6</em> fusion) was compared between CLDN18.2-positive and -negative tumors. Clinicopathological variables, including age, sex, race, Lauren classification, metastatic site, PD-L1 CPS, CLDN18.2 status, and receipt of hyperthermic intraperitoneal chemotherapy (HIPEC), were evaluated. Survival outcomes were estimated using the Kaplan–Meier method, and univariate and multivariate Cox regression analyses were carried out to identify prognostic factors.</div></div><div><h3>Results</h3><div>Thirty-eight tumors (54%) were CLDN18.2-positive. CLDN18.2-negative tumors were more likely to harbor <em>KRAS</em> mutations and higher PD-L1 CPS. No significant differences in overall survival (OS) or progression-free survival (PFS) were observed between CLDN18.2-positive and -negative groups. Among all covariates, metastatic burden (oligometastatic versus polymetastatic) and race were independently associated with OS. In contrast, age, sex, histology, PD-L1 CPS, and CLDN18.2 expression were not prognostic. HIPEC did not significantly improve PFS or OS compared with non-HIPEC treatment; however, a trend toward improved outcomes suggests potential benefit in selected patients, supporting further prospective evaluation.</div></div><div><h3>Conclusions</h3><div>CLDN18.2 and PD-L1 expression delineate distinct molecular and metastatic subgroups of GC/GEJ cancer. Personalized strategies integrating biomarker-driven systemic and regional therapies may enhance outcomes in this heterogeneous disease. Although HIPEC did not significantly improve survival, the observed trend warrants further validation in prospective studies.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"10 ","pages":"Article 100261"},"PeriodicalIF":0.0,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466171","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 impact of socioeconomic status with overall survival in hepatocellular carcinoma: a systematic review and meta-analysis","authors":"W.Y. Chua ,&nbsp;O. Lim ,&nbsp;D. Tai ,&nbsp;S.Y. Lee ,&nbsp;J.J.X. Lee ,&nbsp;H.C. Toh ,&nbsp;B.K.P. Goh ,&nbsp;H.L. Tan ,&nbsp;Y.X. Koh ,&nbsp;J.P.E. Chang ,&nbsp;K.Y.Y. Ng","doi":"10.1016/j.esmogo.2025.100259","DOIUrl":"10.1016/j.esmogo.2025.100259","url":null,"abstract":"<div><h3>Background</h3><div>Hepatocellular carcinoma (HCC) is the sixth most common malignancy and the second leading cause of cancer-related mortality worldwide. Patients are typically diagnosed at an advanced stage, with a poor prognosis. Despite recent therapeutic advances in HCC, there are concerns about the accessibility of these treatments for patients of lower socioeconomic status (SES), which may lead to poorer outcomes and exacerbate health inequity.</div></div><div><h3>Methods</h3><div>We searched MEDLINE and Embase from inception to 26 April 2024 to identify cohort studies comparing SES indicators and HCC outcomes. We computed hazard ratios (HRs) with accompanying 95% confidence intervals (CIs) for each study and pooled the results using a random-effects meta-analysis. Quality assessment was carried out using the Newcastle–Ottawa Quality Assessment Scale.</div></div><div><h3>Results</h3><div>In this meta-analysis of 15 studies involving 199 404 patients, we analysed the impact of SES on overall survival in patients with HCC. Lower income (HR 1.10, 95% CI 1.02-1.18, <em>P</em> &lt; 0.01) and lower insurance coverage (HR 1.22, 95% CI 1.12-1.32, <em>P</em> = 0.01) had a negative impact on overall survival from HCC, but we were unable to stratify by stage. Absent or reduced insurance status had a negative impact on overall survival from HCC, regardless of the stage of HCC (early-stage HR 1.18, 95% CI 1.03-1.36 versus all-stage HR 1.25, 95% CI 1.13-1.38).</div></div><div><h3>Conclusion</h3><div>Lower income and insurance coverage negatively impacted overall survival from HCC. Absent or reduced insurance status negatively impacted overall survival from HCC, regardless of the stage of HCC. Further studies from low- to middle-income and Asian countries are needed. There is an urgent need to develop policies to reduce the survival gap between patients with HCC of differing SES status.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"10 ","pages":"Article 100259"},"PeriodicalIF":0.0,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362425","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":"Heads or tails? In-depth analysis of pancreatic cancer outcome according to tumor location","authors":"A. Fernandes ,&nbsp;A. Lambert ,&nbsp;A. Tarabay ,&nbsp;A. Hollebecque ,&nbsp;C. Smolenschi ,&nbsp;M. Valéry ,&nbsp;T. Pudlarz ,&nbsp;A. Fuerea ,&nbsp;G. Camilleri ,&nbsp;M. Delaye ,&nbsp;V. Boige ,&nbsp;M. Ducreux ,&nbsp;A. Boilève","doi":"10.1016/j.esmogo.2025.100245","DOIUrl":"10.1016/j.esmogo.2025.100245","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic ductal adenocarcinoma (PDAC) is expected to become the second deadliest cancer in Europe by 2030. Given the underlying differences in embryogenesis, the objectives of this study were to describe the clinical and molecular features and outcomes of PDAC based on the primary tumor location [head (H) or body/tail (B/T)].</div></div><div><h3>Patients and methods</h3><div>A retrospective single-center study included patients with a histologically confirmed PDAC and known tumor location from 2012 to 2024. The molecular panels included in-house panel on tumor tissue, FoundationMedicine® (tumor tissue) or FoundationOne Liquid CDx® (liquid biopsy) panels. HR and <em>P</em> value were computed via Cox regression between H versus B/T tumors.</div></div><div><h3>Results</h3><div>A total of 1011 patients were included, among them 520 patients (51%) with H-tumor. Molecular alterations were available for 373 patients. Most common genes altered were <em>KRAS</em> (78%), <em>TP53</em> (69%), <em>CDKN2A</em> (24%), and <em>SMAD4</em> (12%), without significant differences between the two groups. Median overall survival (OS) from diagnosis was 20.6 months [95% confidence interval (CI) 19.2-22.6 months] in H tumors compared with 16.2 months in B/T tumors (95% CI 14.2-17.8 months, <em>P</em> = 0.00057). Median OS from metastatic diagnosis was 14.4 months in H tumors (95% CI 13.4-16.7 months) versus 12.9 months in B/T tumors (95% CI 11.0-14.9 months, <em>P</em> = 0.033). In multivariable analysis, operated patients [hazard ratio (HR) 0.36, <em>P</em> &lt; 0.001], lung-only metastases (HR 0.55, <em>P</em> = 0.003) and low neutrophil/lymphocyte ratio (HR 0.56, <em>P</em> &lt; 0.001) were associated with a longer OS while liver metastases (HR 1.25, <em>P</em> = 0.02) and B/T primary tumor site (HR 1.23, <em>P</em> = 0.03) worsened the prognosis.</div></div><div><h3>Conclusions</h3><div>In a large retrospective cohort, H-PDAC was found to have a longer median OS than B/T-PDAC from initial and metastatic diagnosis.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"10 ","pages":"Article 100245"},"PeriodicalIF":0.0,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324496","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":"Hypoalbuminemia during zolbetuximab plus chemotherapy for claudin 18.2-positive advanced gastric cancer: a need for caution?","authors":"K. Shimozaki ,&nbsp;A. Ooki ,&nbsp;S. Fukuoka ,&nbsp;T. Hirasawa ,&nbsp;M. Takamatsu ,&nbsp;H. Kawachi ,&nbsp;T. Wakatsuki ,&nbsp;K. Yoshikawa ,&nbsp;K. Yoshino ,&nbsp;S. Udagawa ,&nbsp;H. Osumi ,&nbsp;M. Ogura ,&nbsp;E. Shinozaki ,&nbsp;K. Chin ,&nbsp;K. Yamaguchi","doi":"10.1016/j.esmogo.2025.100257","DOIUrl":"10.1016/j.esmogo.2025.100257","url":null,"abstract":"<div><h3>Background</h3><div>Despite several studies highlighting the importance of zolbetuximab-induced gastrointestinal toxicity, the incidence of and risk factors for severe hypoalbuminemia during zolbetuximab plus chemotherapy for the treatment of claudin 18.2-positive advanced gastric cancer have not been fully elucidated.</div></div><div><h3>Materials and methods</h3><div>We retrospectively evaluated 29 patients (median age, 62 years; men, 45%; diffuse-type histology, 76%; prior total gastrectomy, 24%). Severe hypoalbuminemia was defined as a serum albumin level ≤2.5 g/dl during or a maximum decrease of ≥1.0 g/dl from baseline during cycle 1 day 1 and cycle 3 day 1 in this cohort.</div></div><div><h3>Results</h3><div>Median serum albumin levels at baseline, cycle 2, and cycle 3 day 1 were 4.0, 3.1, and 3.4 g/dl, respectively. The median maximum change in serum albumin from baseline was –1.0 (range –1.6 to 0.3) g/dl. Grade 3 hypoalbuminemia was observed in two patients (6.9%). The absence of a history of total gastrectomy before systemic treatment, the use of oxaliplatin and capecitabine, body mass index ≥19.8, and nausea/vomiting during zolbetuximab infusion at cycle 1 were identified as predictive biomarkers for developing severe hypoalbuminemia.</div></div><div><h3>Conclusion</h3><div>This study highlights the clinical significance of developing severe hypoalbuminemia during treatment with zolbetuximab plus chemotherapy and identifies possible risk factors.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"10 ","pages":"Article 100257"},"PeriodicalIF":0.0,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324497","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":"Development of a novel routine blood-based AI model for HCC screening—a territory-wide study","authors":"K.-N. Kwok ,&nbsp;K.-M. Chueng ,&nbsp;S.J.-L. Lam ,&nbsp;M. Seo ,&nbsp;C.Y. Lau ,&nbsp;P.Y.-M. Woo ,&nbsp;H.-S. Lam ,&nbsp;S.-M. Yip ,&nbsp;S. Lam ,&nbsp;O.-P. Chiu ,&nbsp;W.W.Y. Sung ,&nbsp;H.H.-W. Liu ,&nbsp;K.K.-H. Bao ,&nbsp;J.C.-H. Chow ,&nbsp;S.K.-K. Ng ,&nbsp;H.H.-Y. Yiu ,&nbsp;D.C.C. Lam","doi":"10.1016/j.esmogo.2025.100241","DOIUrl":"10.1016/j.esmogo.2025.100241","url":null,"abstract":"<div><h3>Background</h3><div>Current guidelines for hepatocellular carcinoma (HCC) screening in patients with chronic liver disease (CLD) recommend ultrasound and/or α-fetoprotein (AFP) testing every 6 months. However, both methods exhibit low sensitivity for early-stage HCC. Building on our previous study that identified a novel blood test signature for HCC, this study aims to develop a routine blood-based artificial intelligence (AI) model for HCC detection.</div></div><div><h3>Patients and methods</h3><div>Records from 2000 to 2018 were retrieved from Hospital Authority Data Collaboration Laboratory, a territory-wide database. CLD (hepatitis/cirrhosis) patients with and without HCC were identified with International Classification of Diseases codes, anti-viral drug history, virology test, and radiology reports. Decompensated cases were excluded. Blood records within 1 month before the diagnosis of HCC and CLD patients were retrieved. Data from 2000 to 2015 were split into training and testing cohorts in an 80 : 20 ratio, while data from 2016 to 2018 were used as the validation set. Machine learning models were applied and their performances were compared with AFP.</div></div><div><h3>Results</h3><div>The cohort yielded &gt;75 000 patients including 19 670 patients with HCC. Results from the test set demonstrated promising capabilities in excluding CLD patients, achieving a sensitivity of 80% and a specificity of 81% (area under the receiver operating characteristic curve = 0.894) at a cut-off value of 0.43. The AI model outperformed AFP in early-stage detection, maintaining higher sensitivity across all Barcelona Clinic Liver Cancer stages.</div></div><div><h3>Conclusions</h3><div>This novel AI model, which uses only standard blood test results, shows strong potential for improving the detection of HCC, significantly outperforming the traditional alpha-fetoprotein (AFP) test. Its straightforward design offers a practical and widely accessible screening option that could be integrated into existing healthcare pathways to aid earlier diagnosis.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"10 ","pages":"Article 100241"},"PeriodicalIF":0.0,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324498","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":"Clinicopathological features and outcomes for colorectal carcinomas with KRAS codon 146 mutations","authors":"R.K. Yang ,&nbsp;A. Rashid ,&nbsp;S. Roy-Chowdhuri ,&nbsp;D.S. Hong ,&nbsp;J. Bryan","doi":"10.1016/j.esmogo.2025.100244","DOIUrl":"10.1016/j.esmogo.2025.100244","url":null,"abstract":"<div><h3>Background</h3><div><em>KRAS</em>-activating mutations characterize ∼40% of colorectal carcinomas (CRCs) and predict resistance to anti-epidermal growth factor receptor therapy. Because the location of <em>KRAS</em> mutations conveys distinct biophysical consequences, we investigated whether CRCs’ clinicopathological features varied by <em>KRAS</em> mutation codon.</div></div><div><h3>Patients and methods</h3><div>CRC patients from 2018 to 2022 were identified from the United States National Cancer Database, which reports <em>KRAS</em> as wild-type versus codon 12/13/61-mutant versus codon 146-mutant. <em>KRAS</em> codon mutations were compared using multivariable logistic regression for clinicopathological features and multivariable Cox regression for overall survival (OS). Notable limitations include a lack of granular codon characterization and detailed treatment data.</div></div><div><h3>Results</h3><div>Nationally, <em>n</em> = 76 581 CRC patients were identified, 43.3% of whom were <em>KRAS</em> mutated (including <em>n</em> = 16 366 at codon 12/13/61 and <em>n</em> = 784 at codon 146). Among tumor characteristics, codon 146-mutated CRCs were less likely poorly differentiated (12.1%) and more likely moderately differentiated (80.7%) than codon 12/13/61-mutated CRCs (15.9% and 76.0%, respectively; <em>P</em> = 0.003). Additionally, codon 146-mutated CRCs less likely involved the sigmoid colon (14.4% versus 18.1% of codon 12/13/61-mutated CRCs; <em>P</em> = 0.004). <em>KRAS</em> codon 146-mutated CRCs were enriched with microsatellite instability-high (MSI-H)/mismatch repair-deficient (dMMR) (10.1% versus 5.9% of codon 12/13/61-mutated; <em>P</em> &lt; 0.001) and were less likely concurrently <em>NRAS</em> mutant (1.5% versus 8.0% of codon 12/13/61-mutated; chi-square <em>P</em> &lt; 0.001). Adjusting for patient characteristics and treatments, no OS difference was observed between <em>KRAS</em> codon 146-mutated and 12/13/61-mutated stage IV CRCs (hazard ratio 0.97, 95% confidence interval 0.84-1.12, <em>P</em> = 0.69).</div></div><div><h3>Conclusion</h3><div>Nationally, CRCs with <em>KRAS</em> mutations at codon 146 exhibited select pathological and MSI/MMR differences—illustrating that <em>KRAS</em> mutations have codon-specific manifestations that warrant further investigation, particularly as the armamentarium of alteration-specific KRAS inhibitors grows.</div></div>","PeriodicalId":100490,"journal":{"name":"ESMO Gastrointestinal Oncology","volume":"10 ","pages":"Article 100244"},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268338","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}