In this special in-person episode filmed straight from the floor at ASCO 2026, Drs. Nicholas Hornstein, Timothy Brown, and Udhayvir Grewal welcome guest Dr. Arvind Dasari (MD Anderson) to discuss why colorectal cancer is officially having its precision medicine moment. From the epidemic of young-onset disease to the frontline tracking of ultra-specific biomarkers, the panel discusses why molecular profiling is now just as critical as a histological diagnosis.
Key discussion points include:
- Universal Testing & The ALASCCA Data: Why every patient—localized or metastatic—requires immediate biomarker staging, including a look at using adjuvant aspirin to target PI3K/PTEN/PIK3CA pathway alterations.
- The CIRCULATE-North America Blueprint: Dr. Dasari shares the technical and regulatory hurdles of designing a major serial ctDNA trial, the removal of the Phase II/III FDA hold, and how the study is dynamically expanding eligibility rules for stage III de-escalation.
- The Turnaround Revolution: A practical look at clinic operations in 2026—how combining liquid biopsy with fast-tracked DPYD and UGT1A1 panels delivers actionable genomic results in under seven days.
- Targeting the Known Frontiers: Breaking down the current state of Breakwater (BRAF V600E), CheckMate 8HW (Nivo/Ipi doublets in dMMR), and the downstream nuances of RAS co-occurrence in HER2-targeted therapies vs. ADCs.
- Post-Conference Takeaways: The panel’s real-time analysis of the major ASCO abstracts, including the Dutch PUMP trial (adjuvant hepatic artery infusion pumps for liver metastases) and the data validating the cessation of immunotherapy for complete responders.
From institutional operator expertise in HAI pumps to the future of “unknown target” molecular glues, this session bridges the gap between massive data drops and Monday morning clinic realities.
Chapters:
00:00 Welcome and Introductions
00:28 Precision Era in CRC
00:54 Meet Dr Dasari
01:46 Early Onset CRC Trends
02:44 Must Know Biomarkers
04:15 Who Gets Molecular Testing
05:51 Tissue vs Liquid Strategy
07:41 CIRCULATE Trial Explained
09:00 Trial Design Challenges
11:06 How It Compares to DYNAMIC
12:45 Accrual and Patient Barriers
14:11 Whats Next in CRC Therapy
16:16 HER2 Positive Approach
17:02 ASCO Highlights and Practice Changers
18:43 Nonoperative and Supportive Care
20:25 HAI Pump PUMP Study
21:45 Closing Thoughts and Sign Off
You can find us on X:Gut Onc Lab (@TheGutOncLab) / X
Contributors:
Dr. Nicholas Hornstein, MD, PhD, is a gastrointestinal medical oncologist and Assistant Professor Northwell Health.
Dr. Timothy Brown, MD, MSCE, is a gastrointestinal medical oncologist and Assistant Professor at UT Southwestern.
Dr. Udhayvir Grewal, MD, MBBS, is a gastrointestinal medical oncologist and Assistant Professor at Emory University School of Medicine.
Dr. Arvind Dasari, MD, MS, is a medical oncologist and Professor and Director of GI Medical Oncology at MD Anderson Cancer Center.