ASCO 2026 Review: A New Era of Smarter, More Selective and Personalized Oncology
In this article
The Most Noteworthy Studies from the ASCO 2026 Cancer Congress
What made ASCO 2026 important was not just the abundance of positive phase 3 results. The particularly noteworthy point in oncology was that two seemingly opposing strategies were gaining strength at the same time. This is no contradiction; on the contrary, it represents the true maturation of personalized oncology.
⬆ TREATMENT INTENSIFICATION
Delivering systemic treatment earlier and more intensively to carefully selected patients with high biological risk.
PROTEUS · RASolute 302 · frontMIND · HARMONi-6 · KEYNOTE-B15/EV-304 · LIBRETTO-432 · EMERALD-3 · MATTERHORN
⬇ DE-ESCALATION
Reducing unnecessary surgery, chemotherapy and radiotherapy burdens in carefully selected patients to achieve the same cancer control with better quality of life.
SENOMAC · OPTIMA · CIRCULATE/GALAXY/ALTAIR · FASTRACK II · SERENA-6 · ARACOG
In the coming period, decisions will no longer be shaped only by the tumor's stage, but also by tumor biology, genomic risk, MRD/ctDNA status, response to treatment, the patient's functional status, quality-of-life goals, and the drug's access and regulatory status .
How should this review be read?
This article examines approximately 50 studies and themes highlighted at ASCO 2026 within the major directions of clinical transformation, rather than as individual news reports. Some studies were published simultaneously in peer-reviewed journals; others are available at the level of abstracts, company announcements or press-programme material. Their levels of evidence are therefore not identical—this distinction is specifically preserved throughout the text.
The showcase of ASCO 2026 was a powerful area of clinical impact created by several major phase 3 trials. Although they involved different cancers, they shared one feature: prompting a rethink of standard treatment paradigms.
| Study | Cancer type | Key data | Clinical significance | Evidence / cautions |
|---|---|---|---|---|
| RASolute 302 | Previously treated metastatic pancreatic adenocarcinoma | n=500; OS 13,2 vs 6,7 months (HR 0,40); PFS 7,3 vs 3,5 months (HR 0,45); ORR 33,2% vs 11,8% | RAS targeting achieved very strong phase 3 survival data in pancreatic cancer for the first time | PRACTICE-CHANGING Phase 3, NEJM; FDA Expanded Access opened |
| PROTEUS | High-risk localized/locally advanced prostate cancer | n=2.109 (two thousand one hundred nine); pCR/MRD 8,9% vs 1,0%; 5-year MFS 78,2% vs 73,5% (HR 0,80); EFS HR 0,71 | Perioperative intensification with apalutamide + ADT around radical prostatectomy | CANDIDATE FOR A NEW STANDARD Phase 3, NEJM; OS maturation must be awaited |
| frontMIND | Newly diagnosed high-risk DLBCL/HGBL | Tafasitamab + lenalidomide + R-CHOP; PFS HR 0,75; 3-year PFS 67,3% vs 60,7% | Strengthening the R-CHOP backbone in high-risk aggressive B-cell lymphoma | CANDIDATE FOR A NEW STANDARD Phase 3; OS and subgroups need follow-up |
| HARMONi-6 | Advanced squamous NSCLC (1st line) | n=532; ivonescimab + chemotherapy vs tislelizumab + chemotherapy; OS 27,9 vs 23,7 months (HR 0,66); independent of PD-L1 | A strong signal for the PD-1/VEGF bispecific approach in squamous lung cancer | CANDIDATE FOR A NEW STANDARD Phase 3; double-blind in China—generalisability requires careful consideration |
| LIBRETTO-432 | RET fusion-positive resected stage IB-IIIA NSCLC | Adjuvant selpercatinib; EFS HR 0,172; median EFS not reached vs 31,8 months; 24-month EFS 91,5% vs 61,1% | Expands the scope of molecular adjuvant treatments in early-stage disease | PRACTICE-CHANGING Phase 3, NEJM; the toxicity balance needs monitoring |
| KEYNOTE-942/V940 | Resected high-risk melanoma | At 5-year follow-up, the risk of recurrence/death fell by 49% and the risk of distant metastasis/death by 59% | A personalized mRNA neoantigen vaccine + pembrolizumab maintains its long-term signal | TO BE FOLLOWED Long-term phase 2b; phase 3 (V940-001) is ongoing |
| SENOMAC | Early breast cancer, 1-2 positive sentinel nodes | Omission of ALND did not compromise long-term survival; quality of life was preserved | Important phase 3 evidence strengthening axillary surgical de-escalation | PRACTICE-CHANGING Phase 3; patient selection and radiotherapy field are critical |
| ROADS | Resection of a large brain metastasis | Implanted "tile-based" radiation/brachytherapy is promising for local control and QoL | Could reshape local radiation strategies after surgery | TO BE FOLLOWED LBA; long-term neurocognitive data must be awaited |
Pancreatic cancer is one of the most difficult areas of modern oncology. In metastatic disease, options are limited after first-line chemotherapy, and the contribution of second-line treatments to survival is usually modest. The difference shown by RASolute 302 should therefore be viewed as historic evidence not only for pancreatic cancer, but also for the druggability of RAS biology — because oncogenic RAS is present in more than 90% of PDAC cases and was considered an "undruggable target" for decades.
RASOLUTE 302 — STUDY DETAILS
- Design: Global, randomized, open-label phase 3; 500 patients (ECOG 0-1), 59 centers in North America, Europe and Asia. Metastatic PDAC after one previous line of chemotherapy.
- Randomization (1:1): Oral daraxonrasib 300 mg/day vs one of 4 standard chemotherapy regimens selected by the investigator.
- Dual primary endpoints: OS and BICR-assessed PFS in the RAS G12-mutant population.
- Efficacy: OS 13,2 vs 6,7 months (HR 0,40—approximately 60% reduction in the risk of death); PFS 7,3 vs 3,5 months (HR 0,45); ORR 33,2% vs 11,8%. Results were also significant in the RAS G12-mutant and overall populations (PFS HR approximately 0,45 and 0,49—broad activity beyond mutation selectivity).
- Safety—a striking difference: Grade ≥3 treatment-related adverse events: 43,6% vs 57,5%; serious adverse events: 10,8% vs 18,7%; treatment discontinuation due to adverse events: only 1,2% vs 11,2%. The main adverse events were rash and stomatitis. Deterioration in pain and quality of life occurred later (HR approximately 0,51 and 0,60).
- Publication: O'Reilly EM, Wainberg ZA, Wolpin BM et al. NEJM, 31 May 2026, DOI 10.1056/NEJMoa2605555 (ASCO Plenary, Abstract LBA5).
What is a RAS(ON) inhibitor?
RAS proteins are major hubs of cell-growth signaling; in cancer, they may remain continuously active ("ON"). Daraxonrasib is an oral, multiselective "tri-complex" inhibitor that targets the active, GTP-bound RAS(ON) state more broadly, rather than a single KRAS submutation. It covers variants such as G12D, G12V and G12R, and partly wild-type RAS.
Important regulatory note
Daraxonrasib has very strong phase 3 data but has not yet received full FDA approval; the FDA has opened Expanded Access , and the data are being submitted to the FDA for an approval application. The correct explanation for patients is: "a very strong candidate for a new standard; routine access depends on national approvals."
How to intensify treatment in early-stage disease was an important theme at ASCO 2026. The central rationale: if a patient has high biological risk, integrating systemic treatment earlier, before metastases develop, may change long-term outcomes. The critical nuance is balancing the benefit against the burden of toxicity —particularly in LIBRETTO-432.
| Study | Disease | Strategy | What is changing? | Points of caution |
|---|---|---|---|---|
| PROTEUS | High-risk localized/locally advanced prostate cancer | Neoadjuvant + adjuvant apalutamide + ADT + radical prostatectomy | Systemic intensification around surgery is a candidate for a new standard | More rash, rare treatment-related deaths, and OS maturation; patient selection must become clearer |
| LIBRETTO-432 | RET fusion-positive early-stage NSCLC | Adjuvant selpercatinib | After EGFR/ALK, RET also enters the field of molecular adjuvant treatment; EFS HR 0,172 is very strong | Grade ≥3 adverse events: 66,7% (placebo 23,7%); discontinuation: 17,3%; elevated ALT/AST, hypertension —the balance between benefit and toxicity needs monitoring |
| MATTERHORN | Resectable gastric/GEJ adenocarcinoma | Perioperative durvalumab + FLOT | Perioperative immunotherapy is a standard in gastric cancer; surgical-feasibility analyses in 2026 provided support | PD-L1/MSI subgroup effects and surgical safety details are important |
| KEYNOTE-B15/EV-304 | Muscle-invasive bladder cancer | Perioperative enfortumab vedotin + pembrolizumab | Chemotherapy–immunotherapy/ADC combinations are moving into the neoadjuvant setting | EV toxicity (neuropathy, skin toxicity, hyperglycemia), patient selection and surgical timing are critical |
De-escalation was one of the most important philosophical themes of ASCO 2026. De-escalation does not mean undertreating ; it aims to provide the same cancer control with better quality of life in carefully selected patients by reducing unnecessary surgery, chemotherapy or radiotherapy burdens on the basis of scientific evidence. The shared message: the price patients pay for treatment matters as much as the outcome.
| Area | Study | Key message | Meaning for patients |
|---|---|---|---|
| Axillary surgery | SENOMAC | ALND can safely be omitted in many patients with 1-2 positive sentinel nodes | Lymphedema, restricted shoulder movement, pain and loss of quality of life may decrease |
| Adjuvant chemotherapy | OPTIMA | Omission of chemotherapy with low genomic risk by Prosigna was non-inferior (5 years: 93,7% vs 94,9%) | Some clinically high-risk HR+/HER2− patients may be spared chemotherapy |
| Axillary staging | SLNB/cALND-CDK4/6 analyses | More aggressive investigation of the axilla solely to establish CDK4/6 eligibility does not appear reasonable | Surgical morbidity and systemic benefit can be discussed in a more balanced way |
| Local treatment of primary kidney cancer | FASTRACK II | SABR is a strong definitive option for inoperable patients; 5-year local control approximately 98% | Local control in 1-3 sessions for selected patients unable to undergo surgery |
| Adjuvant colon cancer | CIRCULATE / ALTAIR / GALAXY | The concept of reducing treatment in ctDNA/MRD-negative patients and intensifying it in positive patients is gaining strength | Unnecessary chemotherapy may be reduced; high-risk patients are identified earlier |
What is de-escalation?
It is not randomly reducing treatment; it is an evidence-based attempt to achieve the same oncological safety with fewer adverse effects, less surgical burden, shorter treatment duration or better quality of life. ASCO 2026 showed that de-escalation is now an active clinical research programme in many tumor types, rather than merely a theoretical concept.
Breast cancer stood out along two directions at ASCO 2026: new ADC and endocrine strategies in metastatic disease on one side, and precision de-escalation reducing chemotherapy and surgical burdens in early-stage disease on the other. OPTIMA (sparing chemotherapy with Prosigna), SENOMAC (omission of ALND) and SERENA-6 (detecting ESR1 mutations using ctDNA before radiological progression and switching early from an aromatase inhibitor to camizestrant) were conceptual studies in this field.
| Study | Patient group | Key message | Level of evidence |
|---|---|---|---|
| OPTIMA | ER+/HER2− early breast cancer, clinically high risk | Omission of chemotherapy with low risk by Prosigna was non-inferior (5 years: 93,7% vs 94,9%) | PRACTICE-CHANGING |
| SENOMAC | cN0, 1-2 positive sentinel nodes | Long-term safety of omitting ALND; reduced axillary morbidity | PRACTICE-CHANGING |
| SERENA-6 | ESR1-mutant HR+/HER2− advanced breast cancer | Early endocrine switching guided by ctDNA (camizestrant) improves PFS/PFS2 | CANDIDATE FOR A NEW STANDARD |
| ASCENT-04 | PD-L1+ metastatic TNBC, 1st line | Sacituzumab govitecan + pembrolizumab provides superior PFS to chemotherapy + pembrolizumab | CANDIDATE FOR A NEW STANDARD |
| dato-DXd (TROPION-Breast02) | PD-L1− / mTNBC not suitable for IO | FDA approval (22 May 2026); PFS 10,8 vs 5,6 months, OS 23,7 vs 18,7 months | FDA APPROVED |
| Izalontamab brengitecan | Metastatic TNBC / low-ER subgroups | The EGFR×HER3 bispecific ADC approach draws attention with a PFS/OS signal | TO BE FOLLOWED |
Lung cancer stood out in several directions at ASCO 2026. In ALK+ disease, the CROWN 7-year update supported the extraordinary durability of lorlatinib's long-term disease control. In EGFR exon 20 insertion disease, WU-KONG28 demonstrated the superiority of sunvozertinib over chemotherapy in the first line. LIBRETTO-432 expanded the scope of adjuvant selpercatinib in RET-positive early-stage disease.
| Study | Subgroup | Key data / message | Practical impact |
|---|---|---|---|
| CROWN (7 years) | ALK+ advanced NSCLC | At 7 years, the PFS rate was approximately 55% in the lorlatinib arm and approximately 3% with crizotinib | Lorlatinib's position as a long-term 1st-line standard is strengthened |
| WU-KONG28 | EGFR exon 20 insertion advanced NSCLC | Sunvozertinib has superior antitumor activity to platinum chemotherapy in the 1st line | A non-chemotherapy 1st-line approach is gaining strength in exon20ins patients |
| LIBRETTO-432 | RET+ resected stage IB-IIIA NSCLC | Adjuvant selpercatinib EFS HR 0,172; 24-month EFS 91,5% vs 61,1% | RET testing also becomes critical at diagnosis in patients with early-stage disease |
| AcceleRET-Lung | RET+ advanced NSCLC | Pralsetinib is effective in the 1st line; infection and safety issues attracted attention | RET-targeted options are expanding; toxicity management is important |
| HARMONi-6 | Advanced squamous NSCLC | Ivonescimab + chemotherapy OS 27,9 vs 23,7 months (HR 0,66); independent of PD-L1 | PD-1/VEGF bispecific therapy is a new area of competition—with the nuance of a Chinese population |
HARMONi-6—a critical nuance
Ivonescimab + chemotherapy demonstrated OS of 27,9 vs 23,7 months against tislelizumab + chemotherapy (HR 0,66; 34% reduction in the risk of death), with benefit independent of PD-L1. However, this is a double-blind phase 3 trial conducted in China; even lead investigator Shun Lu explicitly framed the result as "a first-line standard in China." Global generalisability requires confirmation in different populations. This is also historic because it is the first oncology drug originating in China to be selected for an ASCO Plenary session.
| Study | Patient group | Key message | Clinical impact / nuance |
|---|---|---|---|
| RASolute 302 | Previously treated metastatic pancreatic cancer | Daraxonrasib nearly doubled OS (HR 0,40) | The era of RAS targeting in pancreatic cancer begins |
| BREAKWATER | BRAF V600E metastatic CRC | Encorafenib + cetuximab + chemotherapy is effective in the first line | Moving BRAF targeting into an earlier treatment line |
| HERIZON-GEA-01 | HER2+ metastatic gastroesophageal cancer | Zanidatamab + chemotherapy ± tislelizumab; OS (tislelizumab arm) 26,4 vs 19,2 months (HR 0,72) | HER2 targeting moves beyond trastuzumab; the control arm was trastuzumab, not a direct comparison with KEYNOTE-811 |
| HORIZON-CRC01 | HER2+, RAS/RAF WT, refractory CRC | Trastuzumab rezetecan PFS 5,5 vs 2,8 months; ORR 40,7% vs 4,5% | The HER2 ADC field in CRC is gaining strength |
| EMERALD-3 | Unresectable HCC suitable for embolization | TACE + STRIDE + lenvatinib PFS 13,0 vs 9,8 months | TACE is now considered in integration with systemic treatment |
| CIRCULATE / ALTAIR / GALAXY | MRD/ctDNA in colon cancer | The distinction between MRD-positive and MRD-negative disease is gaining strength in adjuvant decisions | High potential to personalize adjuvant chemotherapy |
| Study | Disease | Key message | Careful interpretation |
|---|---|---|---|
| PROTEUS | High-risk localized/locally advanced prostate cancer | pCR/MRD and MFS benefit with apalutamide + ADT (EFS HR 0,71) | Patient selection, adverse-event burden and OS maturation are important |
| Decipher / genomic classifiers | Prostate cancer | Refine intensification and de-escalation decisions alongside clinical risk | Not a standalone decision tool; multidisciplinary interpretation is required |
| ENZAMET (Decipher) | mHSPC | The role of genomic tools in distinguishing docetaxel benefit and prognosis was discussed | The predictive/prognostic distinction must be made clearly |
| KEYNOTE-B15/EV-304 | Muscle-invasive bladder cancer | Perioperative EV + pembrolizumab; a strong pCR/EFS/OS signal | Neuropathy, skin toxicity, hyperglycemia and surgical timing |
| POTOMAC | BCG-naive high-risk NMIBC | Durvalumab + BCG received FDA approval; the key evidence is DFS superiority | The context is DFS, not OS; patient selection and toxicity |
| RAMPART | RCC after resection (adjuvant) | Durvalumab ± tremelimumab has a DFS signal; QoL may be affected early | Careful comparison with the adjuvant pembrolizumab standard (KEYNOTE-564) |
| miR-371 / SWOG S1823 | Testicular cancer surveillance | High negative predictive value in relapse surveillance; potential to reduce the imaging burden | Sensitivity limitations and the implementation algorithm need clarification |
| Study | Disease | Main approach | Clinical significance |
|---|---|---|---|
| frontMIND | High-risk DLBCL/HGBL | Tafasitamab + lenalidomide + R-CHOP | Strengthening the R-CHOP backbone in high-risk patients (PFS HR 0,75) |
| SUCCESSOR-2 | Relapsed/refractory multiple myeloma | Mezigdomide + carfilzomib + dexamethasone | The new CELMoD class (cereblon E3 ligase modulators) comes to the forefront |
| SUNMO | R/R large B-cell lymphoma | Mosunetuzumab + polatuzumab vedotin vs R-GemOx | A bispecific antibody + ADC strengthens the alternative to chemotherapy |
| Epcoritamab + mini-CVP | Elderly/unfit DLBCL | A bispecific antibody + low-intensity chemotherapy | Frailty-focused lymphoma treatments are gaining importance |
| PRMT5 inhibitor | Hodgkin lymphoma (and others) | An early signal from a new epigenetically targeted class | The horizon of epigenetic targeting in lymphoma is expanding |
| CONQUER / CD5 CAR-T | T-ALL / PTCL | CD5-targeted CAR-T | The horizon of cellular treatment in T-cell malignancies is expanding |
| Study | Rare/difficult area | Key data | Practical message |
|---|---|---|---|
| SARC041 | Dedifferentiated liposarcoma | Abemaciclib PFS 9,7 vs 1,5 months (HR 0,38) | The first positive phase 3 study of CDK4 targeting in a rare sarcoma |
| PEAK | Advanced GIST after imatinib | Bezuclastinib + sunitinib PFS 16,5 vs 9,2 months (HR 0,50) | Dual KIT inhibition could change the 2nd-line GIST standard |
| OptimUM-02 | HLA-A2-negative metastatic uveal melanoma | Darovasertib + crizotinib PFS 6,9 vs 3,1 months; ORR 37,1% vs 5,8% | A strong targeted candidate in the HLA-A2− group outside the tebentafusp setting |
| FASTRACK II | Inoperable primary kidney cancer | No local recurrence in 70 patients during long follow-up; pooled 5-year local control approximately 98% | SABR as definitive local treatment in selected inoperable patients |
| Pivekimab sunirine | Blastic plasmacytoid dendritic cell neoplasm (BPDCN) | A new FDA approval for a CD123-targeted ADC | A new targeted ADC option in a rare hematological tumor |
At ASCO 2026, not only drugs but also biomarker-development technologies attracted attention. Digital pathology, artificial intelligence and spatial analyses of the tumor microenvironment are moving biomarkers beyond a "positive/negative" assessment towards reading the tumor's map . The assessment now considers not just whether a target is present, but where it is within the tumor, whether immune cells enter the tumor, how the stromal barrier behaves, and the locations of tumor-infiltrating lymphocytes and tertiary lymphoid structures (TLS).
A PARADIGM SHIFT IN BIOMARKERS
- Old: Is the target present or absent? Is PD-L1 high, HER2 positive, or MSI present?
- New: Where is the target, how dense is it, and which cells are its neighbors?
- Microenvironment: Have T cells entered the tumor? Is there a stromal barrier? Have TLS formed?
- Decision support: An AI model combines pathology and clinical data to predict treatment response and risk.
This field remains largely at the "to be followed / hypothesis-strengthening" level; it is not a routine-practice standard, but is one of the strongest directions for the future.
What is spatial profiling?
It means analyzing not only the number of cells in tumor tissue, but also their positions relative to one another. It seeks answers to questions such as whether T cells have entered the tumor or remained only at the edge, and how they relate to the vascular and stromal structures. This is increasingly important, particularly for interpreting immunotherapy response and ADC target expression.
At ASCO 2026, GLP-1 receptor agonists, short-term fasting, exercise, yoga and weight management were discussed with a growing body of scientific data. Quality-of-life-focused studies of cognitive outcomes in survivorship, for example, ARACOG —comparing darolutamide and enzalutamide in blood–brain barrier penetration and cognitive effects—showed that treatment selection involves not only survival, but also how that survival is lived . Reports associating GLP-1 agonists with better survival or less progression in breast cancer and other tumors are exciting.
The correct message for metabolic oncology
Obesity, insulin resistance, diabetes, muscle loss and inflammation may affect cancer treatment response. However, most GLP-1 data are observational and associative; they do not establish causality. There is no evidence sufficient to recommend "adding GLP-1 to cancer treatment," and no GLP-1 agent is approved for a cancer treatment or prevention indication. Approaches such as short-term fasting around chemotherapy also require careful assessment of sarcopenia, diabetes, nutrition and patient selection. These are supportive or potentially complementary areas; they do not replace standard treatment.
One of the most important distinctions for patients reading this article: positive results for a drug at a congress do not mean that it can immediately be prescribed or accessed in our country.
| Agent / approach | Area | Regulatory status | The correct explanation for patients |
|---|---|---|---|
| Daraxonrasib | Metastatic pancreatic cancer | Strong phase 3 data; FDA Expanded Access, not full approval | A very strong candidate for a new standard; routine access depends on approvals |
| dato-DXd (Datroway) | PD-L1− mTNBC | FDA approved (22 May 2026); NCCN Category 1; the process in Turkey is awaited | Approved in the United States; national access must be assessed separately |
| Darovasertib + crizotinib | HLA-A2− uveal melanoma | Not yet FDA approved; an NDA is targeted | Promising, but in the regulatory process |
| Bezuclastinib + sunitinib | GIST after imatinib | FDA Priority Review process | If approved, it could change the 2nd-line GIST standard |
| Durvalumab + BCG | BCG-naive high-risk NMIBC | Received FDA approval (POTOMAC) | Now in the realm of clinical implementation, access and reimbursement |
| NOUS-209 | Cancer prevention in Lynch syndrome | FDA Fast Track, not approval | A candidate cancer-preventive vaccine; not in routine use |
| Puxitatug samrotecan | B7-H4+ endometrial/ovarian cancer | Phase 1/2a data; phase 3 is ongoing | A strong early signal; phase 3 must be awaited before becoming a standard |
TOPICS THAT MAY BE MISUNDERSTOOD—THE CORRECT FRAMEWORK
- POTOMAC: It must not be presented as OS evidence; it should be described in the context of FDA approval and DFS superiority.
- HARMONi-6: OS data are strong (HR 0,66), but it was a double-blind trial in China; the lead investigator himself called it "a standard in China." Global generalisability must be confirmed separately.
- HERIZON-GEA-01: The control arm was trastuzumab + chemotherapy, not the pembrolizumab + trastuzumab of KEYNOTE-811; a direct comparison cannot be made.
- LIBRETTO-432: EFS HR 0,172 is very impressive, but grade ≥3 adverse events were 66,7%, with 17,3% treatment discontinuation—the benefit must be presented together with the toxicity burden.
- GLP-1 data: Most are observational/associative; causality or a recommendation to "add it to routine oncology" must not be inferred.
- persevERA / giredestrant: Not HER2+; it should be considered alongside lidERA and SERENA-6 as an oral SERD strategy in ER+/HER2− disease.
- NOUS-209: Fast Track ≠ FDA approval; headlines claiming "a cancer-preventive vaccine has been found" must not be used.
- Amivantamab social-media reports: It is not a vaccine; it is not yet an FDA-approved standard in head and neck cancer.
- SABR / FASTRACK II: It must not be said to have replaced surgery in operable patients; it is a strong option for selected inoperable or high-risk patients.
- ROADS, AI/spatial profiling and lifestyle topics: Not practice-changing; they should be positioned as "to be followed / hypothesis-strengthening."
PRIORITIES FOR CURRENT CLINICAL AND ACADEMIC PRACTICE
- 1. Molecular testing at diagnosis: EGFR, ALK, ROS1, RET, MET, HER2, BRAF, MSI, NTRK, HRD—not limited to advanced disease, these also affect early-stage decisions.
- 2. MRD/ctDNA infrastructure must be strengthened: MRD-guided decisions will increase in fields such as colon cancer, RCC, prostate cancer and testicular cancer.
- 3. A culture of de-escalation: Avoiding unnecessary axillary surgery, chemotherapy or overtreatment benefits patients.
- 4. Treatment intensification must be selective: PROTEUS, KEYNOTE-B15/EV-304 and MATTERHORN strengthen early systemic treatment in high-risk disease—toxicity, for example in LIBRETTO-432, must be balanced against benefit.
- 5. Regulatory status must be stated clearly: ASCO data, Fast Track, Priority Review and FDA approval must not be confused.
- 6. ADC toxicity management must be standardized: Center-specific algorithms for ILD/pneumonitis, cytopenias, neuropathy, skin, gastrointestinal and ocular toxicities.
- 7. Immunotherapy toxicity boards: Hepatitis, colitis, endocrinopathies, pneumonitis and neurological toxicities must be recognized early.
- 8. Digital pathology and AI infrastructure are strategic: Biomarkers will be interpreted together with the tumor's map and microenvironment.
- 9. Phase 3 data in rare tumors must be followed: SARC041, PEAK, FASTRACK II and OptimUM-02 show major differences in small fields.
- 10. Patient-reported outcomes must become routine: Fatigue, cognitive function (ARACOG), pain, diarrhea, sleep and quality of life must be measured.
- 11. Metabolic health is part of care: Obesity, insulin resistance, diabetes, muscle loss and nutrition—but the level of evidence must be communicated honestly.
- 12. The language of well-founded hope: Scientific, calm communication rather than "miracle," "cancer is over" or "a vaccine has been found."
- 13. Multidisciplinary boards must be expanded: Molecular tumor boards, MRD boards, toxicity boards and quality of life considered together.
- 14. Financial and access realities: Accessibility, reimbursement and national conditions must be explained as well as approval status.
- 15. Rapid news and in-depth analysis must be distinguished: Not every ASCO report has to be a review; selected major themes should be addressed comprehensively.
🗣 How should ASCO 2026 be explained to patients and their families?
"Very important advances in cancer treatment were announced at ASCO 2026. In some difficult cancers, new targeted drugs extended survival; in some early-stage cancers, reassuring results supported reducing unnecessary treatment. However, every new study does not immediately mean a standard treatment for everyone. Whether a treatment is appropriate for you must be assessed according to your cancer type, stage, molecular tests, previous treatments, general health and the drug's availability in our country."
⚡ WHY DOES IT MATTER?
The strongest message of ASCO 2026 is that oncology is no longer just "a race to develop stronger drugs." This congress reminded us to choose treatment more intelligently, intensify it at the right time, reduce it boldly when appropriate, and accept the patient's quality of life as an inseparable part of success. While RASolute 302 (RAS targeting in pancreatic cancer) and PROTEUS (perioperative intensification in prostate cancer) showed where intensification makes sense, SENOMAC, OPTIMA and MRD/ctDNA studies opened discussion of which patients can safely receive less treatment.
✅ STRENGTHS
The congress supported numerous positive phase 3 results with simultaneous NEJM/Lancet/JCO publications (RASolute 302, PROTEUS, LIBRETTO-432). Both breakthroughs in targets previously considered "undruggable," such as oncogenic RAS, and mature phase 3 evidence supporting de-escalation demonstrated the field's maturation in two directions. The inclusion of biomarkers, MRD and patient-reported outcomes, including cognitive health during survivorship, in the main programme signals oncology's evolution towards a holistic view extending beyond the tumor.
⚠️ LIMITATIONS AND CAUTIONS
The studies do not have equal levels of evidence: some offer mature phase 3/NEJM data, while others are abstracts or company announcements. HARMONi-6 involves a China-specific population; the HERIZON-GEA-01 control arm was trastuzumab, not a direct comparison with KEYNOTE-811. OS remains immature in many intensification studies (PROTEUS), and the toxicity burden may be substantial (LIBRETTO-432: 66,7% grade ≥3). GLP-1 and lifestyle data are observational. "Presented at ASCO" ≠ "approved" ≠ "accessible in Turkey." Even very strong candidates, including daraxonrasib, have not yet reached the stage of full approval or reimbursement.
🩺 IMPLICATIONS FOR CLINICAL PRACTICE
Success in today's practice means determining the most appropriate treatment intensity by considering the patient's biology, genomic risk, MRD status, functional status, quality-of-life goals and access conditions together, rather than giving every patient the newest treatment. Molecular-testing and MRD infrastructure, multidisciplinary boards and toxicity-management algorithms form the operational backbone of this transformation. Decision trees in pancreatic cancer (RAS), gastric cancer (HER2/perioperative IO), TNBC (TROP2 ADC) and prostate cancer (perioperative treatment) are being updated after this congress.
❓ QUESTIONS FOR THE FUTURE
When will daraxonrasib receive full FDA approval and national access? Will RAS targeting move into the first line and other RAS-dependent tumors, such as colorectal and lung cancers? Will HARMONi-6 be confirmed in populations outside China? In which tumors will MRD-guided de-escalation become standard? Will the OS data for perioperative intensification (PROTEUS) confirm the PFS/MFS signal? When will spatial/AI biomarkers enter routine decision-making? How can access to molecular testing and MRD in Turkey be brought to a level that meets the needs of this personalized era?
ASCO 2026 showed three directions gaining strength simultaneously in oncology. First, biological targets are being translated into drug treatments more boldly—RAS, RET, HER2, B7-H4, PRAME, CDK4, KIT and CD123 are finding clinical applications in different tumors. Second, treatment intensity in early-stage cancer is being adjusted more precisely: perioperative intensification for some patients, reduction of surgery or chemotherapy for others. Third, the patient experience is moving to the center of clinical decisions—quality of life, cognitive function, toxicity management and real-world sustainability.
The most important lesson from this congress is that the future question in cancer treatment is not only "which drug is more effective?" The real question is: which patient, with which biological risk, benefits most from which treatment, at which intensity, at what cost to quality of life and under which access conditions? ASCO 2026 showed that the answers are becoming more scientific, data-driven and patient-centered. Oncology is moving from the era of "more treatment" to the era of "more appropriate treatment."
References
- O'Reilly EM, Wainberg ZA, Wolpin BM, et al. Daraxonrasib or Chemotherapy in Previously Treated Metastatic Pancreatic Cancer (RASolute 302). NEJM, 31 May 2026. DOI: 10.1056/NEJMoa2605555 (ASCO Plenary, Abstract LBA5).
- Johnson & Johnson. PROTEUS phase 3 results in high-risk localized/locally advanced prostate cancer (EFS HR 0,71; MFS HR 0,80; pCR/MRD 8,9% vs 1,0%). ASCO 2026; simultaneous NEJM publication.
- ASCO 2026. LIBRETTO-432: adjuvant selpercatinib in resected stage IB-IIIA RET fusion+ NSCLC (EFS HR 0,172; 24-month EFS 91,5% vs 61,1%). Simultaneous NEJM publication.
- Lu S, et al. HARMONi-6: ivonescimab + chemotherapy vs tislelizumab + chemotherapy in advanced squamous NSCLC (OS 27,9 vs 23,7 months, HR 0,66). ASCO 2026 Plenary, Abstract LBA4.
- ASCO 2026. frontMIND: tafasitamab + lenalidomide + R-CHOP in high-risk DLBCL/HGBL (PFS HR 0,75).
- FDA, Oncology Center of Excellence. Datopotamab deruxtecan-dlnk (Datroway) approval for PD-1/PD-L1-ineligible mTNBC, 22 May 2026 (TROPION-Breast02; Dent R et al., Annals of Oncology, April 2026).
- Shitara K, Elimova E, et al. Zanidatamab with and without Tislelizumab in HER2-Positive Gastroesophageal Cancer (HERIZON-GEA-01). NEJM 2026;394:2002-2014. (Control arm: trastuzumab + chemotherapy.)
- Merck & Moderna. KEYNOTE-942 / mRNA-4157 (V940) 5-year update. ASCO 2026.
- ASCO Press / Reuters. SENOMAC (axillary de-escalation) and OPTIMA (Prosigna-guided omission of chemotherapy, 5 years: 93,7% vs 94,9%). 2026.
- FDA. Durvalumab + BCG approval for high-risk NMIBC (POTOMAC). 2026.
- Pfizer. CROWN 7-year update, lorlatinib in ALK+ NSCLC. ASCO 2026.
- ASCO 2026 abstract database: BREAKWATER, HORIZON-CRC01, EMERALD-3, SARC041, PEAK, OptimUM-02, FASTRACK II, SUCCESSOR-2, SUNMO, WU-KONG28, AcceleRET-Lung, CIRCULATE/ALTAIR/GALAXY, SERENA-6, ASCENT-04, ROADS, ARACOG, ENZAMET-Decipher, miR-371/SWOG S1823, pivekimab sunirine (BPDCN), puxitatug samrotecan, izalontamab brengitecan.
- drozdogan.com. Archive of ASCO 2026 preview articles and current oncology analyses.
This article is intended as medical news, a review and information; it does not provide individual treatment guidance. Studies presented at ASCO 2026 do not all have the same level of evidence: some are mature phase 3 data simultaneously published in peer-reviewed journals; others are abstracts, company announcements or interim analyses. Positive results for a drug at a congress do not mean that it can immediately be prescribed or accessed in Turkey. FDA Fast Track, Priority Review and full approval are different statuses; TİTCK approval and SGK reimbursement are assessed separately. HARMONi-6 is a double-blind study conducted in a Chinese population, and its global generalisability must be confirmed separately; the HERIZON-GEA-01 control arm was trastuzumab + chemotherapy and cannot be directly compared with KEYNOTE-811, which includes pembrolizumab + trastuzumab. The strong EFS benefit in LIBRETTO-432 must be considered together with its substantial toxicity burden (grade ≥3: 66,7%). Most GLP-1 and lifestyle data are observational and do not establish causality. Patients must always discuss treatment decisions with their own oncologists, considering individual disease characteristics and current approval status. All data were verified against official ASCO 2026 presentations and abstracts, simultaneous NEJM/Lancet/JCO publications, FDA approval notifications and statements by the relevant institutions and companies.
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