Colorectal cancer is now the leading cause of cancer-related death for Americans under 50. I’m proud to introduce the Colorectal Cancer Early Detection Act to give states and healthcare providers the resources they need to better inform and treat the public, expand access to lifesaving screenings, and improve health outcomes.

Obviously, the news that $BNTX and Roche are stopping their cancer "vaccine" study in adjuvant colorectal cancer is not good. It's also not that big a surprise. This is a reminder that this technology won't work in every cancer and may work best in the areas where medicines like Keytruda are already effective. Keytruda is only used in colorectal cancer when it is driven by defects in DNA repair (MSI-High or mismatch repair deficient cancer). So this was a longer-shot trial. The one to watch for the $BNTX is pancreatic cancer. The biggest market for such treatments -- and the one valuations will swing on -- is non-small cell lung cancer, which is also the big market for Keytruda. This is probably less of a big deal than it seems at first glance. $BNTX $ARCT $MRNA $MRK are all down.

New episode of @TheGutOncLab . With a twist: we got a surgeon on. 🔪 Dr. Robert Martin joined @TimothyJBrownMD and me to talk colorectal cancer liver metastases. CRLM is one of the few spaces in metastatic GI oncology where “curable” is still on the table. But the window is narrow, and biology matters. A few highlights: 🔪 The question is not just “can we remove it?” but “how and what should we remove it?” 🩸 ctDNA is getting hard to ignore, but it should not automatically mean “more chemo forever.” Repeat it. Watch the kinetics. Get the right imaging. Discuss as a team. Surgery with biology-first thinking. New episode out now with Dr. Robert Martin, @TimothyJBrownMD, and me. OncoNexus (Out Now): Spotify (To Be Posted 7/27): Apple (To Be Posted 7/27): @UGrewalMD @OncoAlert @Onco_Nexus

How often does a company stop an actively enrolling global phase III trial and open an entirely new registration study? Well, it happened last week. Agenus is moving from BATTMAN to ROBBIN (which certainly has some ethical implications for starting/stopping a study I won't comment on). BATTMAN was testing BOT/BAL against best supportive care in refractory MSS metastatic colorectal cancer. An important question, but a best supportive care control was never likely to gain traction in the United States. ROBBIN moves BOT/BAL where it may have its best chance to work: previously untreated, high-risk stage II/III MSS colon cancer, before surgery and while the primary tumor remains intact. The rationale borrows from FOxTROT and builds on early neoadjuvant immunotherapy work from MSK and others like @pashtoonkasi . The early BOT/BAL data are compelling: • Pathologic response in approximately 60–70% • Major pathologic response in ~35–40% • pCR in ~30% Those are extraordinary numbers for MSS colon cancer and outperform the chemotherapy experience from FOxTROT. ROBBIN will randomize 850 patients to short-course neoadjuvant BOT/BAL followed by standard care versus standard care alone, with event-free survival as the primary endpoint. Will the pathologic responses translate into fewer recurrences? I think there is a real chance they will. The tradeoff will be toxicity. Grade 3 colitis/diarrhea occurred in 13% in one of the early cohorts, although there were no grade 4 events and almost no impact on surgical timing. So yes, you can still smell the colitis. But it may be worth it. @TheGutOncLab @Onco_Nexus @oncodaily @OncoAlert