🧬 Very early (30-39y) vs early (40-49y) onset mCRC
⚠️ Worse OS: 30 vs 38 months
🧬 More KRAS mut.
📉 Fewer APC alt.
🫃 More peritoneal metastases (32% vs 20%)
🎯 Patients aged 30–39 may represent a distinct, more aggressive subtype of EOCRC.
@OncoAlert
🔗 https://t.co/R8H7T48L3B
Trifluridine/tipiracil and survival in mismatch repair-deficient metastatic colorectal cancer - Pei-Hung Chang, Wen-Kuan Huang, Yu-Li Su, Feng-Che Kuan, Jason Chia-Hsun Hsieh, Hung-Chih Hsu, 2026 https://t.co/1PRVfbCRGo
In this 4th pearl in #Clinicalpearlsinoncology series, let's learn how 5FU can rarely cause leukoencephalopathy which can cause serious consequences and why being aware of it is important to act in time. This was the third case I had encountered in my practice.
#CPOseries#5FU
Think of a tumor as a block of wood.
RECIST uses a tape measure. It asks only one question: did the tumor get smaller?
But targeted therapy often works like termites. The tumor may look the same size from the outside while dying from the inside.
RECIST says: Stable Disease.
Biology says: Major Response.
That’s why Choi Criteria matter.
Instead of looking only at size, Choi also measures tumor density (Hounsfield Units) on CT. A ≥15% drop in density can indicate treatment response even before meaningful shrinkage occurs.
💡 Clinical pearl:
For GIST, RCC, and HCC, a tumor that isn’t shrinking may still be responding.
Sometimes the most important change isn’t the size of the tumor.
It’s what’s happening inside it.
#Oncology #MedTwitter #GIST #Radiology
@OncoAlert@ASCO@myESMO
Not all patients receiving moderately emetogenic chemotherapy (MEC) carry the same risk of chemotherapy-induced nausea and vomiting (CINV).
The MyRisk trial tested a simple but important concept: combine patient-specific risk factors with chemotherapy risk to guide antiemetic prophylaxis.
Among high-risk MEC patients, risk-adapted escalation with NEPA + dexamethasone improved:
• Complete response: 81.0% vs 71.8%
• No emesis: 95.4% vs 86.7%
• Complete protection: 71.8% vs 62.4%
Perhaps the most important message:
Treat the patient's emetic risk, not just the chemotherapy's emetic risk.
#Oncology #MedicalOncology #SupportiveCare #CINV #Antiemetics #MASCC #ESMO #ASCO #MVOnco
📊 Understanding Median Survival
A common question from patients:
“Doctor, if the median overall survival improves by 1.9 months, does that mean every patient lives only 1.9 months longer?”
Not quite.
Median survival is a statistical summary of a clinical trial. It tells us when 50% of patients have experienced the event. It helps researchers, regulators, and oncologists compare treatments.
But patients do not live at the median.
Some derive little benefit.
Some derive substantial benefit.
Some do better than the median.
Some do worse.
That is why Kaplan–Meier curves matter. They show the entire survival experience of the trial population—not just a single point where the curves cross 50%.
Using NAPOLI-3 as an example:
• Median OS: 11.1 vs 9.2 months
• HR: 0.83
• 12-month survival: 45.6% vs 39.5%
• 18-month survival: 26.2% vs 19.3%
The key takeaway:
The median is a property of the trial.
The patient has their own survival curve.
Median ≠ Individual Prognosis.
#Oncology #PancreaticCancer #ClinicalTrials #EvidenceBasedMedicine #MedicalEducation #MVOnco
🆕🗞️Pancreas cancer & #KRAS revolution updates continue. We treated last patient Nov 2024.
📚🧬KRAS Vaccine💉
While ITT DFS wasn’t significant, 2 signals emerge👇🏽:
✔️R0 resection☢️
✔️mKRAS-T-cell responders🔴
➡️👟Gearing up for phase-3.
💭@OncoAlert
🔗https://t.co/KEBHbtn5Do
Why Performance Status Is Not Enough in Elderly Patients
A 75-year-old with ECOG 1 may appear fit, yet have hidden vulnerabilities such as cognitive impairment, malnutrition, falls, polypharmacy, or poor social support.
Performance Status measures activity.
Geriatric Assessment measures reserve.
To treat older adults safely, we must look beyond ECOG and identify the factors that truly influence toxicity, treatment tolerance, and outcomes.
#MVOnco #GeriatricOncology #Frailty #CancerCare
#ASCO26
This one is special.
This is the hottest paper of 2026 and potentially in the history of pancreatic cancer.
Let’s dive in.
RASolute 302: Daraxonrasib vs investigator’s choice chemotherapy in previously treated metastatic pancreatic cancer
Abstract LBA5 (soon!)
Presentation: May 31, 2026, 3:21-3:33 PM CDT
For decades, pancreatic cancer has been where good ideas go to die.
We have optimized chemotherapy. We have sequenced chemotherapy. We have celebrated modest gains.
But the central driver of PDAC has always been sitting there in plain sight:
RAS.
More than 90% of pancreatic cancers have oncogenic RAS mutations, and until recently, we had essentially nothing direct to do about it.
Daraxonrasib is an oral RAS(ON) multiselective inhibitor targeting the active GTP-bound state of mutant and wild-type RAS.
And in RASolute 302, it delivered.
Quick hits:
📌 Phase 3 international randomized trial 500 patients with previously treated mPDAC Daraxonrasib vs investigator’s choice chemotherapy
🧬 RAS G12 population
91.8% of patients had RAS G12 mutations
📈 OS in RAS G12 population
13.2 vs 6.6 months
HR 0.40
P<0.001
📈 OS in overall population
13.2 vs 6.7 months
HR 0.40
P<0.001
📊 PFS in RAS G12 population
7.3 vs 3.5 months
HR 0.45
P<0.001
📊 PFS in overall population
7.2 vs 3.6 months
HR 0.49
P<0.001
🔥 12-month OS
Overall population: 53.2% vs 17.3%
⚠️ Toxicity matters, but this was not just more efficacy for more toxicity
Grade ≥3 AEs: 61.8% vs 69.6%
TRAEs leading to discontinuation: 1.2% vs 11.2%
This is the kind of survival curve we almost never get to see in pancreatic cancer.
This validates RAS(ON) inhibition in the most RAS-addicted major cancer. It takes a target we have talked about for decades and turns it into a clinically meaningful survival benefit in a randomized phase 3 trial.
The next questions come fast: 1L combinations, maintenance, perioperative disease, sequencing, resistance, toxicity management, and whether this becomes a new backbone.
RAS is here, and it couldn’t have come sooner.
https://t.co/Y4WJRlRRTk
@TheGutonclab@UGrewalMD@TimothyJBrownMD@OncoAlert@Onco_Nexus@ASCO@NazliDizman@LauraAlderMD@DVAraujoMD@DrBarbiOnc@LauraEsfeller@FunchainMD@YGaritaonaindia@DrSAHaddad@jgong15@iandresmeraz@SakditadMD@RamilaShilpakar@RohitBanwar@lungoncdoc