The OJC S4E8: Beam Me Up, Scotty! STAR-TREC, Viagra & the Ethics of $55K Cancer Drugs

us? I have got, and I've cheated, I have to say.

So Wellington listeners, you've heard this before.

So I want to talk about Commit.

which was published in JCO July 2026, a randomized study of M. Folfox 6, Bevacizumab, Atezolizumab, or Atezolizumab alone as first-line treatment of deficient DNA mismatch repair metastatic colorectal cancer.

So everybody knows DMMR, colon cancer, responds well to immunotherapy, at least in part.

Keynote 177, a first-line pembroke versus chemo, significant difference in progression-free survival, weren't able to prove statistically significant OS, partly for a variety of reasons.

But we're all using it.

Checkmate 8H4, first line ipinevo versus chemo, stonkingly high survival.

At four years, we're close to 70%.

This trial, the original design, designed years ago, as is the problem with trials, chemo anti-VGF, Folfox Bev versus atezolizumab alone versus chemobevacizumab atezolizumab.

The chemobevacizumab arm was dropped because Keynote 177 was published.

And so no one wanted to go into that arm.

Then sadly, Checkmate AHW, the Epinevo paper, was then published in the middle of their recruitment.

So they were actually only able to recruit 100 patients per And this is just a problem, an attempted trial design that wasn't able to recruit for a variety of reasons.

Yeah, and this is over eight years.

I'm just looking at the abstract, eight years recruitment per 100 patients.

I think it is a useful question, too, because we use chemo IO routinely in other disease types that we expect a response to immunotherapy.

And we do see early loss of patients with DMMR colon cancer who are started on IO and get early progression and don't do well.

And maybe this is a strategy to get them out.

As you'd expect when you use all of the active therapies up front rather than in sequence, the progression-free survival is longer.

At the two-year progression-free survival being 54% versus 32%, weren't able to demonstrate an overall survival.

The two-year overall survival is 67% in both arms.

Sadly, also the quality of life data, there's no difference, which I think is fascinating, probably because that's giving people who are living the longer also getting the chemo up front.

Then the editorial was quite scathing of the absolute outcomes compared with pembrolizumab.

So both arms underperformed was there.

us? I have got, and I've cheated, I have to say.

So Wellington listeners, you've heard this before.

So I want to talk about Commit.

which was published in JCO July 2026, a randomized study of M. Folfox 6, Bevacizumab, Atezolizumab, or Atezolizumab alone as first-line treatment of deficient DNA mismatch repair metastatic colorectal cancer.

So everybody knows DMMR, colon cancer, responds well to immunotherapy, at least in part.

Keynote 177, a first-line pembroke versus chemo, significant difference in progression-free survival, weren't able to prove statistically significant OS, partly for a variety of reasons.

But we're all using it.

Checkmate 8H4, first line ipinevo versus chemo, stonkingly high survival.

At four years, we're close to 70%.

This trial, the original design, designed years ago, as is the problem with trials, chemo anti-VGF, Folfox Bev versus atezolizumab alone versus chemobevacizumab atezolizumab.

The chemobevacizumab arm was dropped because Keynote 177 was published.

And so no one wanted to go into that arm.

Then sadly, Checkmate AHW, the Epinevo paper, was then published in the middle of their recruitment.

So they were actually only able to recruit 100 patients per And this is just a problem, an attempted trial design that wasn't able to recruit for a variety of reasons.

Yeah, and this is over eight years.

I'm just looking at the abstract, eight years recruitment per 100 patients.

I think it is a useful question, too, because we use chemo IO routinely in other disease types that we expect a response to immunotherapy.

And we do see early loss of patients with DMMR colon cancer who are started on IO and get early progression and don't do well.

And maybe this is a strategy to get them out.

As you'd expect when you use all of the active therapies up front rather than in sequence, the progression-free survival is longer.

At the two-year progression-free survival being 54% versus 32%, weren't able to demonstrate an overall survival.

The two-year overall survival is 67% in both arms.

Sadly, also the quality of life data, there's no difference, which I think is fascinating, probably because that's giving people who are living the longer also getting the chemo up front.

Then the editorial was quite scathing of the absolute outcomes compared with pembrolizumab.

So both arms underperformed was there.