OncoUpdates

Evidence-based oncology updates | Trials
• Guidelines
• Practice-changing data | Clinical perspective
& commentary

[Enrique Grande @drenriquegrande]

Neoadjuvant systemic therapy in kidney and bladder cancer: where do we stand?

In MIBC, the landscape has shifted — EV+pembrolizumab and IO combinations are expanding options beyond cisplatin-based NAC, with ctDNA-guided adjuvant strategies emerging.

In RCC, neoadjuvant therapy remains investigational. Early IO±TKI trials show feasibility, but validated pathologic response criteria are still lacking.

https://t.co/9ByykrtZFq

@JCO_ASCO #BladderCancer #KidneyCancer

[Dr Rishabh Jain @DrRishabhOnco]

🚨 ESMO updates metastatic pancreatic cancer guidance: daraxonrasib enters the algorithm.

In previously treated RASG12-mutated metastatic PDAC, ECOG PS 0–1, ESMO now recommends daraxonrasib monotherapy after chemotherapy failure [I, A].

📌 RASolute 302
Daraxonrasib 300 mg OD vs investigator-choice chemotherapy in previously treated metastatic PDAC.

📊 RASG12-mutated population
• OS: 13.2 vs 6.6 months
HR 0.40, P<0.001
• PFS: 7.3 vs 3.5 months
HR 0.45, P<0.001
• ORR: 33.2% vs 11.8%

💡 Why it matters
RAS has long been one of pancreatic cancer’s hardest targets. Daraxonrasib produced a striking survival advantage and has now moved into the ESMO treatment algorithm.

⚠️ Evidence is strongest for RASG12-mutated, ECOG 0–1 disease. Benefit in RASG13, RASG61 and RAS-wild-type tumors remains uncertain.

@ASCO @oncoalert
#PancreaticCancer #KRAS #PrecisionOncology #Oncology

[OncoUpdates @onco_updates]

Very encouraging activity with combined androgen blockade in AR-positive salivary gland carcinoma.

[The ASCO Post @ASCOPost]

In the Japanese phase 2️⃣ DISCOVARY trial, darolutamide + goserelin showed activity in AR-positive salivary gland carcinoma, with a 45.2% objective response rate and median PFS of 13.1 months.
▪️Makoto Tahara, MD, PhD &amp; Susumo Okana, MD, PhD| @JCO_ASCO
🔗 https://t.co/pWaVDpABRx

[OncoUpdates @onco_updates]

@pistoto2017 @mgonzalezvelMD @NEJM @g_mountzios Interesting point. Cross-trial comparisons are difficult, but differences in platinum-free interval and patient selection may partly explain the variation in topotecan outcomes.

[OncoUpdates @onco_updates]

@Erman_Akkus @OncoAlert The OS–PFS disconnect with nivo–ipi remains striking: early progression in some, yet an impressive long-term survival tail.
— The real challenge is identifying who can safely receive a chemo-free strategy upfront.

[OncoUpdates @onco_updates]

@ASCOPost @michael_overman @JCO_ASCO Impressive signal.

[OncoUpdates @onco_updates]

@g_procopio_ @dici_mattia @marcos130990 @valentina79g @elena_verzoni @Simorota6 @elegusma @oncodaily @IstTumori @TargetOncology Thank you! Agree, it would be very interesting to test an early switch strategy based on PSA response.

[OncoUpdates @onco_updates]

@MDmanishshah @montypal @DrChoueiri @tompowles1 @myESMO Impressive rPFS benefit.
The key question now is whether earlier 177Lu-PSMA-617 provides a meaningful advantage over reserving it for progression, particularly with crossover allowed. Mature OS and long-term safety data will be crucial for defining the optimal sequencing.

[OncoAlert @OncoAlert]

FDA Approval🚨 Based on PSMAddition in #ProstateCancer
Source: Novartis

The FDA approved lutetium Lu 177 vipivotide tetraxetan plus an ARPI for PSMA-positive metastatic hormone-sensitive prostate cancer, nearly doubling the eligible patient pool. Based on the Phase III PSMAddition trial, the combination cut progression/death risk by 28% initially (HR 0.72), improving to 33% (HR 0.67) at updated analysis, with a favorable but still-maturing overall survival trend (HR 0.80). Since mHSPC is incurable and roughly half of patients progress within 20 months, this extends lutetium Lu 177 vipivotide tetraxetan earlier in the treatment journey

https://t.co/73j7Qjg0Q9

@DrChoueiri
@tompowles1
@apolo_andrea
@neerajaiims
@montypal
@Silke_Gillessen
@AOmlin
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@PGrivasMDPhD
@TiansterZhang
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@AmandaNizamMD
@drenriquegrande
@BraunMDPhD
@EfstathiouEleni
@nataliagandur
@crisbergerot

@realbowtiedoc
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@DaisukeKotani

[Yüksel Ürün @DrYukselUrun]

Can a virus help make immunotherapy work again?

FDA grants accelerated approval to oncolytic viral therapy Tudriqev + nivolumab after anti-PD-1 progression in advanced melanoma.

24% responded. Median response duration: 14.1 months. @US_FDA @OncoAlert @OpenMedicineHQ

[OncoUpdates @onco_updates]

@dr_yakupergun @MatthewKurianMD @OncBrothers @ErikaHamilton9 @PTarantinoMD @hoperugo @DrSGraff @BijoyTelivala @drsarahsam @stolaney1 @nerealiamd @SKabrajiMD @VKaklamani Agreed on the follow-up concern. I’m also curious whether late recurrence could narrow the apparent benefit of de-escalation in the N2/ROR≤60 group, given the natural history of HR+ disease.

[OncoUpdates @onco_updates]

@DrYukselUrun @OncoAlert @Uromigos @OpenMedicineHQ @myESMO Exactly. EV + pembrolizumab has largely solved the first-line question, but created a new sequencing challenge.

[OncoUpdates @onco_updates]

@Erman_Akkus @OncoAlert Excellent and very practical summary of the ESMO 2026 mCRC recommendations.

[OncoUpdates @onco_updates]

@ChandrakanthMv A well-conducted negative trial with an important clinical message

[MV Chandrakanth @ChandrakanthMv]

Ribociclib + Letrozole: A New Benchmark in Recurrent LGSOC?

The phase II GOG 3026 trial adds to the growing evidence supporting CDK4/6 inhibition in recurrent low-grade serous ovarian cancer.

Key findings
• ORR: 30.6% (1 CR, 14 PR)
• Clinical benefit rate: 84%
• Median duration of response: 21.2 months
• Median PFS: 14.5 months
• Primary endpoint successfully met (15 responses observed; ≥8 required)

Clinical perspective
• Durable responses were observed despite inclusion of patients across multiple prior lines of therapy.
• Reinforces the biologic rationale for combining endocrine therapy with CDK4/6 inhibition in ER-positive LGSOC.
• Although encouraging, these results come from a single-arm phase II study and await confirmation in randomized trials.

Slomovitz et al. JCO 2026.

#LGSOC #OvarianCancer #GynOnc #CDK46 #Ribociclib #Letrozole #MedicalOncology #JCO #MVOnco

[Dr Rishabh Jain @DrRishabhOnco]

🚨 FDA expands the role of Enhertu in curative-intent HER2+ early breast cancer.

AstraZeneca + Daiichi Sankyo’s trastuzumab deruxtecan is now approved in the US in BOTH:
🔹 Neoadjuvant setting (DESTINY-Breast11)
🔹 Adjuvant residual disease setting (DESTINY-Breast05)

Key data 👇

🔹 DESTINY-Breast11
Enhertu → THP vs ddAC-THP
📈 pCR:
67.3% vs 56.3%
Absolute improvement: +11.2% (p=0.003)

🔹 DESTINY-Breast05
Enhertu vs T-DM1 in residual disease
📉 IDFS events reduced by 53%
(HR 0.47)

📊 3-year IDFS:
92.4% vs 83.7%

This potentially reshapes BOTH pre-op and post-op HER2+ early breast cancer management.

But important caution:
⚠️ ILD/pneumonitis remains clinically relevant.
In DESTINY-Breast05:
• ILD: 9.6% with Enhertu
• 2 treatment-related deaths reported

Still, this is a major move of T-DXd deeper into curative-intent disease.

📖 Full details:
AstraZeneca press release

#BreastCancer #OncoTwitter #MedTwitter @OncoAlert @myesmo @esmo_open @asco

[Yakup Ergün @dr_yakupergun]

Algorithm for Systemic Therapy in Early HR+/HER2- Breast Cancer

(Recommendations in gray areas reflect my own clinical judgment— eg. olaparib and CDK4/6 sequence)

[OncoUpdates @onco_updates]

@DrRishabhOnco Are you satisfied with the overall survival results?

[MV Chandrakanth @ChandrakanthMv]

KEYNOTE-689 vs NIVOPOSTOP
Two strategies integrating immunotherapy in curative HNSCC:
• Peri-operative IO
• Post-operative IO intensification
Different designs — same goal: improving cure rates.
Quick comparison 👇
#MVOnco #HNSCC #Immunotherapy