Personalized Care in GI Cancer and More on Biomarkers and Clinical Trials

Dr. Suneel Kamath, a gastrointestinal medical oncologist at Cleveland Clinic in Ohio and an assistant professor of medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, sat down for an interview with CURE.

During the discussion, he explained the key takeaways for patients from the 2026 ASCO Gastrointestinal Cancers Symposium. Additionally, he imparted more key updates from the meeting in another article from CURE!

CURE: What key message should patients take away from the 2026 ASCO Gastrointestinal Cancers Symposium?

Kamath: Similar to the phase 3 HERIZON-GEA-01 trial, what’s really the overall theme of these is that we have to identify specific biomarkers for as many people as we can, because when we identify a specific biomarker driving a cancer, we know that the efficacy of the drugs we use to treat that target will be much greater.

Often on the flip side, we can have a much better side effect profile compared with an untargeted treatment like chemotherapy or even some of the more aggressive immunotherapies. We generally think of those as a big advance, but some of those actually can be quite toxic because they aren’t as targeted in certain settings. Having a targeted, biomarker-driven approach can really improve both outcomes and tolerability. It’s upon us to try to push that envelope, identify more biomarkers, so that we can cut down the number of people for whom we only have untargeted therapies.

KRAS mutations are common in pancreatic and other cancers. Can you discuss the significance of KRAS testing and other emerging targeted therapies? 

Another one that’s on the horizon, we’ve known about the KRAS gene for a long time as a really important driver mutation in a number of cancers, the most important being pancreatic. Over 90% of pancreatic cancers have KRAS mutations. But only recently have we been able to develop drugs that can actually target that. That’s truly exciting. It’s not a rare biomarker. If we had an effective drug for this gene, that would be an effective therapy for more than 90% of people with pancreatic cancer, and that would truly be an advance. With more time, the hope is that we start to identify more targets so that we can personalize treatments for every individual patient and every individual tumor, rather than relying on untargeted regimens.

This also emphasizes the importance of doing that testing. It’s still something that we lag behind in, in a big way, especially when it comes to getting results on every patient with advanced disease. We have to do it in everyone. We may think we’re doing a great job, but as physicians, we really need to work on that. Patients can also be strong advocates for this. There have certainly been situations where people came in and asked whether a specific test had been done, and it turned out it hadn’t.

Originally, there was an assumption that there wasn’t enough tissue or that there was some reason it couldn’t be done, and it turned out that there was. People asking about it has helped lead to that testing being completed. Patients are encouraged to be their own advocates and help remind clinicians to do the things they’re supposed to be doing, too.

How do you address patient concerns on the topic of clinical trial participation? What do you want patients to understand about the potential benefits of the experience?

The biggest thing I always try to emphasize for people regarding clinical trials in the cancer space is that you are never going to be a "guinea pig." That is often a fear many people have, and it is very understandable. In cancer clinical trials, active treatment is always given; patients receive at least the routine standard of care that we provide today. You are not going to get less treatment than you should; there is really only the opportunity to potentially get more. I would view it through that lens, that it is a potential advantage, really.

The other thing I would emphasize is that while it might feel very new or like you are taking a big risk, I always like to remind people that every medication we use today was originally studied in a clinical trial. Before the FDA approved these treatments, some people had access to those drugs years before anyone else because they participated in a trial. So, while it certainly feels risky and scary in many ways, it is often a great way for people to get access to newer therapies before they are otherwise available.

I also emphasize that being in a clinical trial is never a coercive situation. If at any point it no longer makes sense for you, you can pull out at any time. Generally, these days, we are designing these trials in a great way where there is usually some sort of biomarker or a good rationale for why a drug will work in a certain disease or for a certain person. I would very much encourage people to look for clinical trials. I think it is often a pathway toward living longer and having better outcomes. We definitely need to achieve that for people today, while also learning how we can do things better for tomorrow.

Transcript has been edited for clarity and conciseness.

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