San Francisco, California – The 2026 ASCO Gastrointestinal Cancers Symposium, held from January 8-10 in San Francisco, showcased groundbreaking research and clinical advances. Experts presented critical new data across gastric, colorectal, pancreatic, and liver cancers. Several randomized phase 2 and 3 trials revealed findings that could change clinical practice for patients with advanced gastrointestinal malignancies. ^[1][2][3]### Advances in Colorectal Cancer Treatment One significant update came from the COMMIT study, focusing on metastatic colorectal cancer that is deficient mismatch repair (dMMR) or microsatellite instability-high (MSI-H). The trial found that combining chemotherapy (mFOLFOX6) and bevacizumab with atezolizumab dramatically extended progression-free survival. Patients receiving this triplet therapy saw a median progression-free survival of 24.5 months. This compares to just over 5 months for patients treated with atezolizumab alone. T^[4][5]he overall response rate also improved significantly to 86.1% with the combination, versus 46% with atezolizumab monotherapy. ^[5]Another real-world study presented at the symposium highlighted the potential of GLP-1 receptor agonists in colorectal cancer prevention. Researchers observed a 26% relative reduction in colorectal cancer incidence among patients taking these drugs, compared to those taking aspirin. T^[6]his finding suggests a new area for investigation in cancer prevention strategies. ### Breakthroughs in Gastric and Esophageal Cancers Patients with HER2-positive metastatic gastroesophageal adenocarcinoma may soon have a new treatment option. Results from the HERIZON-GEA-01 trial showed that zanidatamab combined with chemotherapy, either with or without tislelizumab, improved progression-free survival. The median progression-free survival was 12.4 months with zanidatamab-based regimens, significantly better than the 8.1 months seen with trastuzumab plus chemotherapy. E^[3][7]lena Elimova, MD, of Princess Margaret Cancer Centre, stated this is the first phase 3 trial to show a benefit for a novel HER2-targeted therapy over trastuzumab in this setting. ^[7]The CRITICS-II trial also provided important insights for resectable gastric cancer. This study suggested that preoperative chemotherapy combined with chemoradiotherapy might offer superior outcomes compared to chemotherapy or chemoradiotherapy alone. T^[6]his could lead to improved treatment strategies before surgery for these patients. Additionally, the NEOSUMMIT-01 trial, conducted in China, explored adding perioperative toripalimab to chemotherapy for locally advanced, resectable gastric or gastroesophageal junction adenocarcinoma. The study reported improved survival outcomes at 3 years and a notable reduction in peritoneal relapse. ^[8][9]### Promising Developments in Pancreatic and Liver Cancers For patients with advanced/metastatic pancreatic ductal adenocarcinoma (PDAC) harboring KRAS G12D mutations, early-phase studies showed promising results. Preliminary phase 1 data for novel oral KRAS G12D inhibitors, INCB161734 and setidegrasib, demonstrated manageable safety profiles and efficacy. These agents were tested as monotherapy or in combination with chemotherapy. T^[3][6]his offers new hope for a cancer type notoriously difficult to treat. A new quadruplet regimen, known as PAAG, also showed significant improvement for patients with treatment-naïve metastatic pancreatic cancer. This regimen combines the anti-PD-1 immunotherapy penpulimab, the antiangiogenic TKI anlotinib, and chemotherapy (nab-paclitaxel plus gemcitabine). It extended median progression-free survival to 7.8 months, compared to 4.5 months with chemotherapy alone. The objective response rate was also higher at 49.52% for PAAG versus 25.92% for chemotherapy alone. I^[10]n hepatocellular carcinoma (HCC), interim analysis from the phase 3b IKF-035/ABC-HCC trial presented a potential shift in treatment for intermediate-stage disease. Systemic therapy with atezolizumab plus bevacizumab showed superior outcomes compared to transarterial chemoembolization (TACE). The median time to failure of treatment strategy was 14.59 months for the combination therapy, versus 9.46 months for TACE. Pe^[11]ter Galle, MD, PhD, stated that based on these positive data, the trial will continue. #^[11]## The Growing Role of Artificial Intelligence Artificial intelligence (AI) emerged as a key theme, with sessions dedicated to its application in GI oncology. Experts discussed how AI could augment clinical care, improve trial matching, and enhance understanding of cancer pathology. On^[1][12]e specific study highlighted BullFrog AI's bfLEAP platform. This AI tool identified biomarkers linked to a nearly threefold increase in survival for a subgroup of pancreatic adenocarcinoma patients treated with glufosfamide. T^[13]he symposium also addressed the increasing number of patients diagnosed with early-onset GI cancers. Sessions focused on their specialized needs, from diagnosis to survivorship, and the importance of genetic screening. W.^[1][12] Kimryn Rathmell, MD, PhD, MMHC, delivered a keynote address on "Meeting Patients With Cancer Where They Are," emphasizing the role of dyad partnerships in oncology and bridging disparities in cancer care, particularly in rural America. T^[2][12]hese findings from ASCO GI 2026 highlight a period of rapid advancement in gastrointestinal cancer treatment, offering new avenues for targeted therapies, immunotherapies, and patient care strategies.

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