ASCO 2026: Key GI Trials Shaping Clinical Practice

Key GI Data From ASCO 2026

Cohosts of the Oncology Brothers podcast, Rahul Gosain, MD, MBA, of Wilmot Cancer Institute, and Rohit Gosain, MD, of Roswell Park Comprehensive Cancer Center, met with Neena Vijayvergia, MD, of Fox Chase Cancer Center, to highlight four major presentations in gastrointestinal cancers at the 2026 American Society of Clinical Oncology Annual Meeting (ASCO 2026). The doctors covered data from the EMERALD-3, FIGHT-302, CIRCULATE, and MATTERHORN trials. 

Survival Outcomes in EMERALD-3

The phase 3 EMERALD-3 trial evaluated the STRIDE (single tremelimumab regular interval durvalumab) regimen with or without lenvatinib plus transarterial chemoembolization (TACE) versus TACE alone in patients with embolization-eligible HCC. 

Compared with TACE alone, STRIDE plus lenvatinib plus TACE significantly improved PFS (HR, 0.70; 95% CI, 0.57-0.86; P = .0007) and trended toward improved overall survival (OS; HR, 0.84; 95% CI, 0.65-1.09; P = .1814). STRIDE plus TACE without lenvatinib also improved PFS (HR, 0.71; 95% CI, 0.56-0.91) and OS (HR, 0.70; 95% CI, 0.51-0.95) versus TACE, according to the ASCO 2026 presentation. 

FIGHT-302: Pemigatinib in the First-Line

Pemigatinib was previously approved as second-line therapy for mCCA with FGFR2 rearrangement based on the FIGHT-202 trial. The FIGHT-302 trial compared pemigatinib with chemotherapy in first-line therapy for mCCA with FGFR2 rearrangement. In the phase 3 trial, median PFS was 8.3 months with pemigatinib versus 6.8 months with gemcitabine plus cisplatin (HR, 0.58; 95% CI, 0.39-0.87; P = .0078). In patients who crossed over to second-line pemigatinib, the median PFS was 8.1 months. 

CIRCULATE Trial: Using ctDNA to Inform Adjuvant Treatment Decisions 

The CIRCULATE trial investigated using postoperative ctDNA to guide adjuvant therapy decisions for patients with stage II colon cancer. The trial randomized 287 patients to observation, which included 15 patients with positive ctDNA, and 26 patients to adjuvant chemotherapy, all with positive ctDNA. Overall, ctDNA–negative patients had significantly higher 3-year disease-free survival (DFS; HR, 0.23; 95% CI, 0.13-0.43; P < .0001) and 3-year OS (HR, 0.18; 95% CI, 0.05-0.61; P = .001) compared with ctDNA–positive patients. 

Out of 26 patients randomized to chemotherapy, 21 initiated adjuvant treatment. In the per-protocol analysis excluding patients who did not start therapy, chemotherapy improved recurrence rates (HR, 0.21; 95% CI, 0.06-0.8) and DFS (HR, 0.28; 95% CI, 0.09-0.94; P = .022) compared with ctDNA–positive patients randomized to observation.

MATTERHORN: EFS Outcomes With Perioperative Durvalumab Plus FLOT 

The MATTERHORN trial previously established perioperative durvalumab plus FLOT (fluorouracil, leucovorin, oxaliplatin, and docetaxel) followed by maintenance durvalumab monotherapy as a new standard of care for patients with resectable gastric or gastroesophageal junction cancer. At ASCO 2026, authors presented event-free survival (EFS) outcomes based on patients’ completed treatment periods. 

Overall, EFS rates were greater for the durvalumab arm compared with the placebo arm, and rates were greatest in patients who completed the full adjuvant regimen. Specifically, in the durvalumab arm, 12-month and 24-month EFS rates were 16 months and 10 months for patients who completed any neoadjuvant treatment but not surgery (HR, 0.80; 95% CI, 0.55-1.18); 59 months and 49.2 months for patients who completed any neoadjuvant treatment and surgery (HR, 0.65; 95% CI, 0.38-1.13); 67.4 months and 46.7 months for patients who completed any adjuvant treatment but not all maintenance (HR, 0.65; 95% CI, 0.46-0.91); and 99.6 months and 91.8 months for patients who completed all adjuvant therapy (HR, 0.63; 95% CI, 0.41-0.97), respectively.