Case Closed: Experts Piece Together the Top Takeaways From the 2025 Gastrointestinal Cancers Symposium

The 2025 Gastrointestinal (GI) Cancers Symposium has officially wrapped, leaving behind a trail of groundbreaking research, debates, and a few ongoing mysteries in the ever-twisting plot of oncology. Over 3 days in San Francisco, California, the brightest minds in GI oncology gathered to crack the case on emerging data, and OncLive had front-row seats to all the action.

Throughout the meeting, OncLive was joined by the following experts with an eye for the most compelling cases in GI oncology:

• Emil Lou, MD, PhD, FACP, associate professor of medicine, the Division of Hematology, Oncology and Transplantation, the University of Minnesota Medical School; medical oncologist, M Health Fairview Masonic Cancer Clinic in Minneapolis
• Shruti Patel, MD, clinical assistant professor, medicine-oncology, Stanford Medicine, California
• Shaalan Beg MD, MBA, FASCO, adjunct associated professor, UT Southwestern Medical Center in Dallas, Texas; senior advisor, clinical research, National Cancer Institute

The trio took over OncLive’s social feeds with the aim of unraveling the biggest breakthroughs in GI cancer and piecing together key insights from the meeting. Together, they covered topics ranging from trends in early-onset colon cancer and gastroesophageal cancer to patient-centric research on palliative care.

“The rise of early-onset GI cancers is rewriting what we thought we knew about these diseases, and studies like these are helping us better understand how to improve outcomes,” said Patel in a recap video for OncLive.

“These conversations are just the beginning, and they’re critical to advancing GI cancer care for the next generation,” Beg added in the video.

In case you missed it, here are some of their exclusive insights on research reshaping early-onset GI cancer from this year’s meeting.

The TAB-EOAO Study Shows Trends With Adjuvant Chemotherapy in Early-Onset Colon Cancer

The TAB-EOAO study compared the use and benefit of adjuvant chemotherapy between patients with early-onset vs average-onset locally advanced colon cancer.1 Eligible patients were identified using the SEER database and were required to have stage II or III disease at diagnosis. Results showed that adjuvant chemotherapy improved cancer-specific survival (CSS) for patients with average-onset colon cancer (HR, 0.69 in patients diagnosed from 2000-2010; HR, 0.50 in patients diagnosed from 2011-2020). Although CSS was not improved in those with early-onset colon cancer from the 2000-2010 group (HR, 1.02), it was improved among those in the 2011-2020 group (HR, 0.76).

Notably, high rates of adjuvant chemotherapy were observed even in low-risk, stage II colon cancer. Additionally, Kaplan-Meyer analysis of CSS indicated limited benefit with adjuvant chemotherapy in high-risk stage II disease.

“This study found that younger patients have been treated more aggressively with adjuvant chemotherapy over the last 2 decades, even when guidelines don’t support it, especially for stage II, low-risk cases,” Lou stated.

“Interestingly, adjuvant chemotherapy did not improve CSS for early-onset patients [diagnosed] between 2002 and 2010, but it did show benefits in the 2011 to 2020 [diagnosis] period,” Patel added. “[Based on these findings], differences in tumor biology, staging, and treatment delivery between these 2 periods needs to be explored. Also, understanding the long-term effect of adjuvant chemotherapy in young patients is critical.”

Molecular Discoveries Have Been Made in Early- vs Average-Onset Gastroesophageal Adenocarcinoma

“[This is] another area we’re excited about,” Beg begins. “Molecular analysis of early-onset gastroesophageal cancer studies are uncovering unique somatic and germline mutations that could explain why these cancers are appearing in younger populations.”

For example, in a retrospective, cross-sectional study, investigators evaluated somatic and germline profiles in patients with early-onset or average-onset esophageal, gastroesophageal junction, or gastric adenocarcinoma of all stages who underwent molecular testing between December 2017 and July 2024.2 The age of average onset was defined as 50 years or older.

Results showed that early-onset gastroesophageal cancer displays a unique mutational profile in comparison with average-onset disease. Furthermore, germline mutations were identified in 1% of patients with early-onset colorectal cancer (CRC; n = 785) vs less than 1% of those with average-onset CRC (n = 5078), indicating that most mutations likely originate from somatic and/or epigenetic alterations.

Palliative Care Consultation Matters

“Beyond treatment, we need to keep the patient experience in focus,” Lou noted. “For example, research shows that inpatient palliative care for early-onset CRC near the end of life reduces aggressive interventions, lowers costs, and improves quality of care for patients and their families.”

One such study, conducted and presented by Suriya Baskar, MD, a second-year resident in the Internal Medicine Department at the Brooklyn Hospital Center in New York, evaluated the effect of formal inpatient palliative care consultation on end-of-life care for patients with esophageal cancer.3 A total of 17,745 patients who had (n = 10,370) and had not (n = 7375) received palliative care consultation were included in the analysis. Notably, patient data were obtained for all esophageal cancer hospitalizations between 2016 and 2020.

Results showed that the mean length of hospital stay was 7.5 days (± 11.3 days) vs 8.9 days (± 14.9) for patients who did and did not receive palliative care, respectively. Moreover, total charges for these respective patient groups were $97,879 (± s $195,868) and $146,128 (± $321,830). Among those who received palliative care consultation, the Charlson Comorbidity Index was 9.4 (± 3.3) vs 9.1 (± s 3.5) for patients who did not. These patients subsequently underwent chemotherapy (0.9% vs 1.6%), blood transfusion (12.3% vs 18%) or mechanical ventilation (28.5% vs 41.0%).

“[Collectively, this research] is a big step forward, but there’s still so much to learn,” Lou concluded.

To check out OncLive’s full coverage from the meeting, click here.

References

1. Bernabe C, Razis D, Moon JY, et al. The TAB-EOAO study: trends in use and benefit of adjuvant chemotherapy between early onset and average onset locally advanced colon cancer. J Clin Oncol. 2025;43(suppl 4):105. doi:10.1200/JCO.2025.43.4_suppl.105
2. Mahipal A, Teslow E, Yu Y, et al. Molecular characteristics of early-onset versus average-onset gastroesophageal adenocarcinoma. J Clin Oncol. 2025;43(suppl 4):496. doi:10.1200/JCO.2025.43.4_suppl.496
3. Baskar S, Schoeneich R, Desai C, Grewal U. Impact of inpatient palliative care consultation on end-of-life care among patients with esophageal cancer. J Clin Oncol. 2025;43(suppl 4):502. doi:10.1200/JCO.2025.43.4_suppl.502