Hello ECAN Community,

As a Board Member of ECAN, I always look forward to the American Society of Clinical Oncology (ASCO) annual meeting in Chicago. It’s the world’s stage for the most impactful new clinical research. And this year, the energy was unmatched.

The 2026 meeting brought together more than 44,000 people from around the globe, all focused on one mission. The groundbreaking clinical trial results presented this year are truly practice-changing and will transform cancer care on a global scale.

While this year’s ASCO meeting didn’t feature immediate, practice-changing breakthroughs for esophageal cancer (EC), several studies showed highly encouraging results.

The most exciting takeaway is the global shift toward precision oncology. The entire research world is focused on personalizing treatments (precision medicine), maximizing the benefits for patients while minimizing risks and side effects. This targeted approach is exactly what will lead to historic breakthroughs for difficult cancers – just like EC.

However, a gap remains between the lab and the clinic. While the esophagogastric research featured this year is promising, more time and funding are urgently needed before these treatments become widely available to our community.

I’m honored to share a medical deep dive into what I learned that will impact our community directly: 

  • Clinical trials by Qilu Pharmaceutical Co. were shared as they researched the CD3 antibody and the investigational agent (QLS31905). This agent, paired with chemotherapy, revealed encouraging results for patients enrolled. Progression-free survival duration of 10.09 months was observed. Overall, the combination of QLS31905 and chemotherapy exhibited manageable safety and efficacy results warranting further study in future clinical trials. This is a big step forward for our community and the results shared that we must continue to support this type of research.
  • The ATTRACTION-6 trial was a randomized, Phase 3 study conducted in Japan, Korea, and Taiwan, focusing on previously untreated patients with HER2-negative advanced gastric and gastroesophageal cancers. In this trial, patients were randomized to receive a combination of nivolumab and ipilimumab (both Bristol Myers Squibb) combined with one of two different chemotherapy regimens, or to receive chemotherapy alone. The rationale behind this clinical trial was to determine whether an approach like this could be successful in gastric and gastroesophageal cancers since this strategy has shown some success in  other cancers where adding this anti-CTLA4-antibody (like ipilimumab) improved efficacy of treatment. Unfortunately, the study results indicated that the combination of ipilimumab and nivolumab with chemotherapy did not lead to improved survival outcomes when compared to chemotherapy alone. Using these complementary immune therapies therefore remains primarily useful in patients with mismatch repair deficient esophagogastric cancers. 
  • The ONO-4578-08 study (Ono Pharmaceutical Co.) was a randomized, Phase 2 clinical trial conducted in Japan, Korea, and Taiwan, focusing on the role of Prostaglandin E2-EP4 signaling in tumor immunosuppression. The Prostaglandin E2-EP4 signaling pathway is known to alter the development and differentiation of myeloid-derived suppressor cells and macrophages, which may contribute to resistance against cancer immunotherapy treatment. In this clinical trial, ONO-4578 was combined with nivolumab (an anti-PD1 antibody) and chemotherapy as an initial treatment for patients with HER2-negative advanced gastric and gastroesophageal junction cancers. Patients in this study either received treatment with ONO-4578 in combination with nivolumab and chemotherapy or a placebo along with nivolumab and chemotherapy. A total of 226 patients were randomized into the treatment groups, and the results indicated that progression-free survival was significantly longer in the group of patients receiving ONO-4578 group compared to the patients receiving a placebo with their chemotherapy and immunotherapy. The overall survival and objective response rates also favored the ONO-4578 treated patients. Larger studies evaluating this treatment strategy are planned.
  • The ASCO Annual Meeting was highlighted by the presented results from the RASolute-302 clinical trial. This clinical trial evaluated daraxonrasib (Revolution Medicines), an oral RAS(ON) inhibitor. The RASolute-302 clinical trial was a Phase III randomized study involving patients who had received prior chemotherapy for their pancreatic cancers. In this trial, daraxonrasib demonstrated a doubling of the median overall survival and progression-free survival compared to traditional chemotherapy, with benefits observed across all patient groups, regardless of age, prior chemotherapy treatment or RAS mutation type. Daraxonrasib did result in an increased incidence of low-grade side effects such as skin rash, mouth sores, and gastrointestinal issues like diarrhea and nausea; it had a lower incidence of severe side effects compared to chemotherapy. Consequently, daraxonrasib is poised to become a new standard of care for patients with pancreatic cancers and may influence future targeting of RAS in other malignancies. Although activating mutations in RAS are relatively rare in esophageal adenocarcinomas, occurring in about 5-10% of cases, RAS amplifications or alterations are linked to more aggressive and metastatic disease. Additionally, mutated RAS has been observed in the progression from Barrett’s esophagus to high-grade dysplasia and esophageal adenocarcinoma, suggesting that RAS inhibitors like daraxonrasib may eventually play a role in the treatment of esophageal adenocarcinomas.

As always, thank you for your support of ECAN!

Albert Craig Lockhart MD, MHS

Division Chief, Division of Hematology and Oncology, MUSC Hollings Cancer Center

ECAN Board Member