Call me Ishmael.

EGFR appears to be this year’s white whale of GI cancer. We already talked about the negative results of adding cetuximab (an EGFR monoclonal antibody) to chemoradiation for esophageal cancer. Now results of the CONKO-005 trial assessing adjuvant gemcitabine +/- erlotinib (an EGFR tyrosine kinase inhibitor) in patients with completely resected pancreatic cancer adds waves to the storm: Adding erlotinib improved neither survival nor disease control. Over half of patients recurred within a year, with a median survival of just over two years. This is sobering news for a rare pancreatic cancer population (with margin-negative resections) for whom we should expect the best possible outcomes. Too bad this trial didn’t have an adaptive design, which may need to be the next sail we cast among these less common GI cancers in our search for substantial survival outcomes that as of yet remain elusive.