Monthly Update: February 2026

Hello everyone, welcome to our monthly newsletter, February 2026 edition.

Exciting Announcement

We have 2 exciting announcements from February!

First, Dr. Bishal Gyawali led the development of ASCO Guidelines on use of WBC Growth Factors in patients receiving cancer treatment. This was published in the Journal of Clinical Oncology, with Dr. Gyawali as the first author. This was his first experience co-chairing an ASCO guideline, and marks a major milestone in his career. He has spoken with ASCO Guidelines podcast and ASCO Daily News in detail about how these guidelines were formulated, what is new, and how they assist oncologists and patients in making evidence-informed shared decisions, taking evidence, benefit, harms, cost, convenience, and equity into account. Read our news post about this.

Second, BG Lab released their first podcast episode this month! In our inaugural episode, BG Lab research assistant, Claire Diana-Gonsalves joins Dr. Gyawali for a wide-ranging discussion that covers: Working in a HIC-setting vs an LMIC-setting, Dr. Gyawali’s pathway to cancer groundshot, teaching and mentorship, future plans for the podcast, and more! We plan to release a new podcast every 3 weeks on YouTube, Spotify, and Apple Podcasts, so stay tuned. Please subscribe, review, and rate us on these channels.

Publications

1. The most important publication to highlight last month was the ASCO G-CSF guidelines we discussed above.

2. As you may recall, BG with Laure-Anne Teuwen and Samuel Stevens had published a comment in The Lancet Oncology back in November 2025 arguing for the use of overall survival as the endpoint in clinical trials of cancer drugs, and made a case for encouraging crossover, except when the drug has not been proven for later lines. They highlighted ARIEL-4 as an example of how patients were saved from harm because ARIEL-4 reported on OS. Please remember that in ARIEL-4, the OS was shortened by 6 months from the use of rucaparib, which was statistically significant. You almost never see this in oncology- shortening survival by 6 months from the new drug! This drug was then withdrawn by most regulators- FDA, EMA, UK- based on these harms. We received a letter to editor about this in which the letter writers, surprisingly, claim that this is a useful drug; a drug that shortens survival by 6 months, which is statistically significant, and wrongly claim that this is due to crossover. In February, we published our rebuttal against that letter in The Lancet Oncology.

3. BG was a collaborator with his Italian colleagues on this paper published in ESMO Open discussing the impact of participants with Eastern Cooperative Oncology Group (ECOG) performance status (PS) 2 on efficacy outcomes in pivotal clinical trials. PS is a measurement of participants’ functional ability (self-care, conducting physical and daily living tasks). They found that there were no significant differences in efficacy between participants with ECOG PS 2 and PS ≤1, higher representation of PS 2 in clinical trials was associated with increased severe adverse effects, treatment discontinuations, and deaths related to adverse effects. They argue for the inclusion of participants with PS 2 in clinical trials as excluding them can limit the generalizability of the results.

Trainee and Mentee News

Media

1. As mentioned, BG Lab released their first podcast episode this month.

2. We were very happy to read the editorial from The Lancet family of journals highlighting areas of enhanced scrutiny for oncology clinical trials published in the journals. These include major recommendations from the CSO-RCT Checklist, that was co-led by BG. We hope other journals follow this lead from The Lancet family of journals, and include these items that improve transparency in reporting of cancer drug trials.

3. BG spoke with Dr. Tessa Cigler on the ASCO Guidelines Podcast discussing important takeaways from the new WBC Growth Factor ASCO Guideline. He was also interviewed for ASCO Daily News on the same topic.

4. BG talked with Marathon of Hope Patient Working Group members Beverley Riediger and Dan Murphy about the intersection of Common-Sense Oncology and Precision Oncology. They discuss CSO, precision medicine, dose optimization, quality of life, and questions patients need to ask while making treatment decisions.

5. Big news! BG Lab has joined Blue Sky! Follow us on this platform for meaningful discussions and frequent updates. Coming soon – a new Instagram account run by our inaugural BG Lab Cancer Groundshot fellow, Dr. Syeda Mina.

6. BG and some of his articles were extensively discussed in this feature article from the February edition of Italian magazine, About Pharma. It’s in Italian, but you can google/AI-translate it, and it’s worth it. It’s titled: “Cancer Drugs: Looking (First and Foremost) at Survival for More Effective Treatments”.

Talks, Presentations, and Meetings

1. In February, BG spoke with the REaCT Clinical trials team in Ottawa about using superiority instead of non-inferiority design for de-escalation trials in oncology. This talk was based on his recent commentary on the same topic published in JNCI.

2. For our GLPH 488 Course, our guest speakers in the month of February included Dr. Ipshita Prakash from McGill University who discussed the status of global cancer surgery, and Dr. Omar Abdihamid from Garissa Regional Cancer Center in Northern Kenya who discussed Global Cancer Care Disparities: Scarcity, Abundance, and the Value of Care.

3. Laure-Anne gave a talk at the Annual Meeting of the Belgian Society of Medical Oncology during the Young Oncology Community session. She talked about critical appraisal of a clinical trial (e.g. cross-over, censoring, control arms, etc.) using the CSO RCT checklist.

Upcoming Events

1. BG is teaching as an invited international faculty at the ASCO-AIOM Clinical Research Course in Rome again this year, just like last year. This year he will teach on different topics, including de-escalation trials in oncology, distinguishing between statistical and clinical significance, and common-sense oncology, and will mentor trainees on critical appraisal workshops.

2. BG is also teaching critical appraisal at the ESO- Certificate of Competence in Breast cancer – sixth cohort (CCB6) course.

From the Archives

BG’s first high-profile commentary was published in August 2016 in JCO titled “Same data; Different Interpretations”. He wrote this commentary with Vinay Prasad, current CBER director at the FDA, who mentored BG on critical appraisal and critical thinking in his early days. This was an informal virtual mentorship since BG was in Japan those days and VP was working at Oregon Health and Sciences University. Over the next few years, BG and VP worked together on several high-profile commentaries, such as questioning the value of testing cancer drugs with poor single-agent activity in combination regimens, using PFS endpoint in trials of maintenance therapies and combination regimens, and the value of me-too drugs in oncology– all three published in Nature Reviews Clinical Oncology. They also highlighted how subgroup analysis can mislead in this commentary published in JAMA Oncology. Their last paper together was on making adjuvant therapy decisions without survival data, published in Annals of Oncology in 2019.

Do you like what we do? You can support us!

The type of work that we do is often not funded by traditional funding channels. If you like our work and want to support us with a donation to our lab, please reach out directly to BG at gyawali.bishal@queensu.ca.

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Thank you for reading and stay tuned for next month’s update!